The Infectious Diseases Society of America (ISDA) recently released the first part of a clinical practice guideline update regarding the diagnosis and management of group A streptococcal (GAS) pharyngitis. This update came from the society’s goal of determining if a scoring system should be used to decide which patients should have diagnostic testing via rapid antigen detection test (RADT), throat culture, and/or molecular methods. 

The consensus reached by the update panel favors the use of a clinical scoring system as part of the evaluation of patients with sore throat, with the main utilities of using a scoring system being to identify patients with low probability of GAS pharyngitis and reduce unneeded testing.

Recommendation of the October 2025 Update

The solitary recommendation provided in this update is as follows:

  • In children and adults with sore throat, we suggest using a clinical scoring system to determine who should be tested for GAS. (conditional recommendation, very low certainty of evidence)

Additionally, the panel suggests that individuals who are at high risk should be strongly considered for testing. At-risk individuals include patients presenting with sore throat who have had household exposure to GAS, a history of previous rheumatic fever diagnosis, or symptoms or signs suggestive of complicated local or systemic GAS infection.

The update also states that the recommendation does not apply to children younger than three since GAS infection in that age range may not present with the clinical features featured in the scoring systems.

The ISDA concludes the update by stating that the true value of a clinical scoring system can be better assessed following additional research, and that artificial intelligence systems combined with clinical scoring is a role that remains to be evaluated.

For a more in-depth look at this clinical practice guideline update, view our summary and the full-text version.

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