Search tips
Search criteria 


Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 1998 February; 48(427): 959–962.
PMCID: PMC1409991

Towards a better diagnosis of throat infections (with group A beta-haemolytic streptococcus) in general practice.


BACKGROUND: Sore throat is a common complaint in general practice. However, management strategies are not very clear. A better diagnostic procedure is needed to prevent the overuse of antibiotics. AIM: To assess the diagnostic value of a rapid streptococcal antigen detection test in addition to four clinical features in patients with sore throat, using throat culture and antibody titres as reference tests. METHOD: Four clinical features [fever (history) > or = 38.0 degrees C, lack of cough, tonsillar exudate, and anterior cervical lymphadenopathy] were registered in 558 patients aged 4 to 60 years presenting with sore throat of no more than 14 days' duration. A rapid diagnostic test was performed, as well as a throat culture and antibody titres [fourfold increase in anti-streptolysin-O (ASO) and/or anti-deoxyribonuclease B (anti-DNAase B)] in patients aged 11 years and older. RESULTS: Throat cultures were positive for group A beta-haemolytic streptococcus (GABHS) in 33% of the patients. Rapid tests were positive in 24%. Compared with the throat culture, the sensitivity of the rapid test was 65%, the specificity 96%, the positive predictive value 88%, and the negative predictive value 85%. However, for patients with three or four clinical features, the sensitivity of the rapid test was considerably higher at 75%. Children (< or = 14 years) had a slightly raised specificity and raised positive predictive value and prevalence. With the antibody titres as a reference, the rapid test performed as well as the throat culture with regard to its predictive value. CONCLUSION: For the management of patients with sore throat in general practice, a rapid test may have an additional value, especially in patients with a high chance of having GABHS infection. However, as the sensitivity of the test studied is low, tests with a higher sensitivity are needed.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (786K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Veasy LG, Wiedmeier SE, Orsmond GS, Ruttenberg HD, Boucek MM, Roth SJ, Tait VF, Thompson JA, Daly JA, Kaplan EL, et al. Resurgence of acute rheumatic fever in the intermountain area of the United States. N Engl J Med. 1987 Feb 19;316(8):421–427. [PubMed]
  • Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM, Kaplan E. Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med. 1989 Jul 6;321(1):1–7. [PubMed]
  • Kaplan EL. The resurgence of group A streptococcal infections and their sequelae. Eur J Clin Microbiol Infect Dis. 1991 Feb;10(2):55–57. [PubMed]
  • Rathore MH, Barton LL, Kaplan EL. Suppurative group A beta-hemolytic streptococcal infections in children. Pediatrics. 1992 Apr;89(4 Pt 2):743–746. [PubMed]
  • Shulman ST. Streptococcal pharyngitis: diagnostic considerations. Pediatr Infect Dis J. 1994 Jun;13(6):567–571. [PubMed]
  • Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1(3):239–246. [PubMed]
  • Dagnelie CF, Touw-Otten FW, Kuyvenhoven MM, Rozenberg-Arska M, de Melker RA. Bacterial flora in patients presenting with sore throat in Dutch general practice. Fam Pract. 1993 Dec;10(4):371–377. [PubMed]
  • Centor RM, Meier FA, Dalton HP. Throat cultures and rapid tests for diagnosis of group A streptococcal pharyngitis. Ann Intern Med. 1986 Dec;105(6):892–899. [PubMed]
  • Kaplan EL, Top FH, Jr, Dudding BA, Wannamaker LW. Diagnosis of streptococcal pharyngitis: differentiation of active infection from the carrier state in the symptomatic child. J Infect Dis. 1971 May;123(5):490–501. [PubMed]
  • Paradise JL. Etiology and management of pharyngitis and pharyngotonsillitis in children: a current review. Ann Otol Rhinol Laryngol Suppl. 1992 Jan;155:51–57. [PubMed]
  • Odio A. Testing for streptococcal pharyngitis. JAMA. 1986 Nov 14;256(18):2516–2516. [PubMed]
  • Radetsky M, Wheeler RC, Roe MH, Todd JK. Comparative evaluation of kits for rapid diagnosis of group A streptococcal disease. Pediatr Infect Dis. 1985 May-Jun;4(3):274–281. [PubMed]
  • Gerber MA. Culturing of throat swabs: end of an era? J Pediatr. 1985 Jul;107(1):85–88. [PubMed]
  • Gerber MA, Spadaccini LJ, Wright LL, Deutsch L. Latex agglutination tests for rapid identification of group A streptococci directly from throat swabs. J Pediatr. 1984 Nov;105(5):702–705. [PubMed]
  • Miller JM, Phillips HL, Graves RK, Facklam RR. Evaluation of the Directigen Group A Strep test kit. J Clin Microbiol. 1984 Nov;20(5):846–848. [PMC free article] [PubMed]
  • Marker SC, Gray ED. Simple method for the preparation of streptococcal nucleases. Appl Microbiol. 1972 Feb;23(2):368–371. [PMC free article] [PubMed]
  • Klein GC, Baker CN, Addison BV, Moody MD. Micro test for streptococcal anti-deoxyribonuclease B. Appl Microbiol. 1969 Aug;18(2):204–206. [PMC free article] [PubMed]
  • Kaplan EL, Ferrieri P, Wannamaker LW. Comparison of the antibody response to streptococcal cellular and extracellular antigens in acute pharyngitis. J Pediatr. 1974 Jan;84(1):21–28. [PubMed]
  • Moyer NP, Quinn PJ, Showalter CA. Evaluation of the Directigen 1,2,3 Group A Strep Test for diagnosis of streptococcal pharyngitis. J Clin Microbiol. 1990 Jul;28(7):1661–1663. [PMC free article] [PubMed]
  • Huck W, Reed BD, French T, Mitchell RS. Comparison of the Directigen 1-2-3 Group A Strep Test with culture for detection of group A beta-hemolytic streptococci. J Clin Microbiol. 1989 Aug;27(8):1715–1718. [PMC free article] [PubMed]
  • Joslyn SA, Hoekstra GL, Sutherland JE. Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis. J Am Board Fam Pract. 1995 May-Jun;8(3):177–182. [PubMed]
  • Lieu TA, Fleisher GR, Schwartz JS. Clinical evaluation of a latex agglutination test for streptococcal pharyngitis: performance and impact on treatment rates. Pediatr Infect Dis J. 1988 Dec;7(12):847–854. [PubMed]
  • Andersen JS, Borrild NJ, Renneberg J. An evaluation of a commercial co-agglutination test for the diagnosis of group A streptococcal tonsillitis in a family practice. Scand J Prim Health Care. 1992 Sep;10(3):223–225. [PubMed]
  • Burke P, Bain J, Lowes A, Athersuch R. Rational decisions in managing sore throat: evaluation of a rapid test. Br Med J (Clin Res Ed) 1988 Jun 11;296(6637):1646–1649. [PMC free article] [PubMed]
  • True BL, Carter BL, Driscoll CE, House JD. Effect of a rapid diagnostic method on prescribing patterns and ordering of throat cultures for streptococcal pharyngitis. J Fam Pract. 1986 Sep;23(3):215–219. [PubMed]
  • Lieu TA, Fleisher GR, Schwartz JS. Clinical performance and effect on treatment rates of latex agglutination testing for streptococcal pharyngitis in an emergency department. Pediatr Infect Dis. 1986 Nov-Dec;5(6):655–659. [PubMed]
  • Harris R, Paine D, Wittler R, Bruhn F. Impact on empiric treatment of group A streptococcal pharyngitis using an optical immunoassay. Clin Pediatr (Phila) 1995 Mar;34(3):122–127. [PubMed]
  • McCusker JJ, McCoy EL, Young CL, Alamares R, Hirsch LS. Comparison of Directigen Group A Strep Test with a traditional culture technique for detection of group A beta-hemolytic streptococci. J Clin Microbiol. 1984 Oct;20(4):824–825. [PMC free article] [PubMed]
  • Bisno AL. Group A streptococcal infections and acute rheumatic fever. N Engl J Med. 1991 Sep 12;325(11):783–793. [PubMed]
  • Dobbs F. A scoring system for predicting group A streptococcal throat infection. Br J Gen Pract. 1996 Aug;46(409):461–464. [PMC free article] [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners