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Algorithms for diagnosing group A streptococcal pharyngitis in adults are quite confusing, in part because advisory bodies differ on when rapid antigen testing can be used alone and when it should be followed with throat culture. Rapid tests have relatively poor sensitivity, but the disease is benign enough in most adults that a high false-negative rate might not be clinically important. In this study, researchers retrospectively reviewed 11 years' worth of laboratory records from two clinical microbiology laboratories in Seattle on >21,000 adolescents and adults with negative rapid strep antigen tests who then had pharyngeal swabs submitted for culture.
For 1023 patients (4.8%), throat cultures grew group A strep. Review of 726 cases with a…