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 streptococcus is suspected.

Tonsillopharyngitis%20-%20acute Signs and Symptoms


  • Tonsillopharyngitis is the acute infection of the pharynx, tonsils, or both
  • Also called strep throat, acute tonsillitis, pharyngitis or adenotonsillitis
  • One of the most common diseases seen in primary care


  • Main cause of acute tonsillopharyngitis
  • Double-stranded DNA viruses (human adenovirus, Epstein-Barr virus), single-stranded RNA viruses [influenza, para-influenza, rhinovirus, enteroviruses, Coxsackie virus, coronaviruses, respiratory syncytial virus (RSV), human meta-pneumo-virus], and retroviruses [human immunodeficiency virus (HIV)] are among the viral causes
  • Responsible for about 5-15% of clinic consultations for acute sore throat in adults 
  • Most commonly caused by Gram-positive cocci known as S pyogenes
    • This organism exhibits beta-hemolysis on blood agar plates
    • Belongs to group A Lancefield classification system for beta-hemolytic strep infection
  • Other bacterial causes include group C and G Streptococci, Haemophilus influenzae, Nocardia, Corynebacteria and Neisseria gonorrhoeae
Mode of Transmission
  • Spreads through person-to-person contact, usually through saliva or nasal secretions from an infected person
  • The primary reservoir of group A streptococcus are the humans
  • The disease is easily transmitted in the following places:
    • Schools
    • Day care centers
    • Military training facilities
  • Transmission via food is rare and if transmission happens, it is most of the time due to improper handling of food
  • Pets and the use of household items such as plates and toys cannot transmit the disease or bacteria

Signs and Symptoms

Clinical Features Suggestive of Group A Beta-Hemolytic Streptococci (GABS) Pharyngitis

  • The incubation period is approximately 2-7 days

Most Classic Symptoms

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

Other Features of GABS 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 and erythema with or without exudates
  • Headache
  • Nausea and 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 and/or enanthem

Risk Factors

  • Commonly infects children aged 5-15 years old and rare in <3 years old
  • Parents of school-aged children and other adults who are in close contact with the infected individual
  • Crowded places like day care centers, schools and military barracks
Editor's Recommendations
Most Read Articles
Pank Jit Sin, 21 May 2020

Persons suffering from asthma should pay particular attention to SARS-CoV-2 precautionary measures such as social distancing, regular handwashing, and wearing of masks on top of keeping their asthma in control. This is because data collected so far paints a bleaker picture for asthmatics than the normal population should they catch COVID-19.

Roshini Claire Anthony, 05 Apr 2021

Primary analysis of the D8110C00001 trial showed that the COVID-19 vaccine AZD1222 had 76 percent efficacy at preventing symptomatic COVID-19.

Roshini Claire Anthony, 12 Apr 2021

Treatment with the human monoclonal antibody tezepelumab reduced exacerbations and improved asthma control, lung function, and quality of life in adults and adolescents with severe, uncontrolled asthma, according to the phase III NAVIGATOR study presented as a poster at AAAAI 2021.

Elvira Manzano, 04 Aug 2020
The global race for a COVID-19 vaccine moves at an unprecedented speed, buoyed by public pressure and geopolitical crosscurrents that were punctuated by deaths and infections around the world.