Fast Five Quiz: Pharyngitis (Sore Throat)

Richard H. Sinert, DO


December 14, 2022

The group A beta-hemolytic streptococcal infection (GABHS) rapid antigen detection test is the preferred method for diagnosing GAS infection in the emergency department. However, only patients with a high clinical likelihood of GAS pharyngitis should be tested. Patients with a Centor score of 0-1 should be treated symptomatically without testing. Throat culture remains the criterion standard for diagnosis of GAS infection; however, it is not ideal for emergency department use because of difficulty with follow-up. Patients can be treated up to 9 days after onset of symptoms to prevent acute rheumatic fever, so immediate antibiotic therapy is not crucial if patients can be easily contacted for follow-up should a culture become positive. The use of the GABHS rapid antigen detection test helps decrease unnecessary antibiotic use in this way.

Complete blood cell count, erythrocyte sedimentation rate, and C-reactive protein level have a low predictive value and are usually not indicated. Imaging studies generally are not indicated for uncomplicated viral or streptococcal pharyngitis. Lateral neck radiography should be done in patients with suspected epiglottitis or airway compromise.

Learn more about pharyngitis workup.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.