An approach to diagnosing the acute sore throat

Sore throat is a common presenting complaint. Although patients often are concerned that they may have group A beta-hemolytic streptococcal (GABHS) pharyngitis, most sore throats are not caused by this infection. A number of illnesses and conditions present as sore throat. After life-threatening conditions are excluded, efforts to identify and treat patients with GABHS pharyngitis are appropriate. Efforts should include a directed history and physical examination, looking for exudative pharyngitis with fever, adenopathy and lack of cough or other respiratory symptoms. These findings predict a positive GABHS culture rate of 50 percent or more. The rapid Streptococcus test has a high positive predictive value, but it has a lower sensitivity rate. Treatment strategies for patients with sore throat are based on epidemiologic factors, signs and symptoms, and results of laboratory tests.