Patients with group A beta-hemolytic streptococcal pharyngitis have classic symptoms of tonsillar swelling/exudates, tender anterior cervical lymphadenopathy, with no cough but with fever of >38ºC.
Clinical features suggestive of a viral etiology are conjunctivitis, absence of fever, coryza, cough, diarrhea, anterior stomatitis, hoarseness, discrete ulcerative lesions, rhinorrhea and viral exanthem and/or enanthem.
Antibiotics will not be needed for every patient that presents with sore throat but it should not be withheld if the clinical condition is severe or group A beta-hemolytic streptococca is suspected.


  • Tonsillopharyngitis is the acute inflammation of the pharynx, tonsils, or both

Signs and Symptoms

Clinical Features Suggestive of Group A Beta-Hemolytic Streptococci  Pharyngitis

Most classic symptoms:

  • Tonsillar swelling/exudates
  • Tender anterior cervical lymphadenopathy
  • Absence of cough
  • Fever >38°C

Other features of Group A Beta-Hemolytic Streptococci  pharyngitis:

  • History of exposure
  • Sudden onset of sore throat
  • Pain on swallowing
  • Petechiae on soft palate (“doughnut” lesions)
  • Scarlet fever rash
  • Beefy red, swollen uvula
  • Tonsillopharyngeal inflammation & erythema w/ or w/o exudates
  • Headache
  • Nausea & vomiting (N/V)
  • Abdominal pain
  • Malodorous breath

Clinical features suggestive of a viral etiology:

  • Absence of fever
  • Conjunctivitis
  • Coryza
  • Cough
  • Diarrhea
  • Anterior stomatitis
  • Hoarseness
  • Discrete ulcerative lesions
  • Rhinorrhea
  • Viral exanthem &/or enanthem
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