Fewer symptoms occur in same-serotype recurrent streptococcal tonsillopharyngitis

Background: Most patients with acute rheumatic fever report no antecedent p haryngitis. Objective: To determine the clinical and microbiological characteristics of recurrent group A P-hemolytic streptococcal (GABHS) tonsillopharyngitis. Design: Prospective randomized trial. Subjects: Symptoms were recorded and throat cultures were obtained at 4 to 6, 18 to 21, and 32 to 35 days follow ing the start of treatment. A subset of 60 patients with subsequent GABHS e pisodes occurring were evaluated for a 0.2-or greater log rise in either an tistreptolysin O or anti-deoxyribonuclease B titer to confirm a bona fide r ecurrence. Results: Sixteen (27%) of 60 patients had recurrent GABHS tonsillopharyngit is of the same serotype that occurred 21 days or longer following the onset of the initial GABHS infection and was associated with a 0.2- or greater l og rise in either antistreptolysin O or antideoxyribonuclease B titer, indi cating bona fide recurrent infection; these recurrences all occurred within 55 days. Fewer patients with recurrent GABHS pharyngitis of the same serot ype had headache (P=.02), sore throat (P=.006), fever (P=.008), pharyngeal erythema (P<.001), pharyngeal edema (P<.001), pharyngeal exudate (P=.04), a nd adenitis (P=.03) compared with the initial episode. Chills, stomachache, scarlatina, tonsillar enlargement, and palatal petechiae were similar for both episodes. Conclusions: Fewer symptoms occur during recurrent GABHS pharyngitis of the same serotype compared with the initial infection. These patients may be l ess likely to seek physician attention, yet their infections put them at ri sk for sequelae.