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Sore throat - acute - Management
When should I investigate?

  • Throat swabs or rapid antigen tests should not be carried out routinely in the investigation of acute sore throat.
  • If the person is at risk of immunosuppression, see the section on Referral.
  • Suspect glandular fever in a person with a sore throat that fails to improve, or becomes worse, after several days. For more information see the section on Investigations in the CKS topic on Glandular fever.
Basis for recommendation
  • Throat swabs:
    • Throat swabs cannot differentiate between infection and carriage, they have poor sensitivity, results take up to 48 hours to be reported, and the analysis is relatively expensive [Little and Williamson, 1996; MeReC, 1999; SIGN, 1999].
    • The results of throat swabs vary according to technique, culture site, and culture conditions [Cooper et al, 2001].
    • Group A beta-haemolytic streptococcus (GABHS) can be isolated from up to 30% of people presenting with sore throat [Bisno, 2005]. However, figures for asymptomatic carriage range from 6% to 40% [Little and Williamson, 1996]. Carriers have low infectivity and are not at risk of developing complications.
    • Swabs may be useful in high-risk groups, to guide the choice of treatment if treatment failure occurs (see the section on Choice of antibiotic).
  • Rapid antigen tests:
    • Rapid antigen tests detect the presence of group A streptococcal antigen on a throat swab and produce results within a few minutes. However, they have poor sensitivity and make little impact on prescribing decisions [SIGN, 1999; Cooper et al, 2001].

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