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 infectio n. A number of illnesses and conditions present as sore throat. After life-threatening conditions are excluded, efforts to identify and trea t patients with GABHS pharyngitis are appropriate. Efforts should incl ude a directed history and physical examination, looking for exudative pharyngitis with fever, adenopathy and lack of cough or other respira tory 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 strat egies for patients with sore throat are based on epidemiologic factors , signs and symptoms, and results of laboratory tests.