Collection

Group A streptococcal infections: guidance and data

The characteristics, diagnosis and management of group A streptococci infections.

• From: UK Health Security Agency
• Published: 31 July 2014
• Last updated: 6 April 2022 — See all updates

Group A Streptococcus (GAS; Streptococcus pyogenes) is a bacterium which can colonise the throat, skin and anogenital tract. It causes a diverse range of skin, soft tissue and respiratory tract infections, including:

• tonsillitis
• pharyngitis
• scarlet fever
• impetigo
• erysipelas
• cellulitis
• pneumonia

In rare cases, patients may go on to develop post-streptococcal complications, such as:

• rheumatic fever
• glomerulonephritis

GAS can occasionally cause infections that are extremely severe. Invasive GAS (iGAS) is an infection where the bacteria is isolated from a normally sterile body site, such as the blood. Any GAS manifestation can be associated with development of streptococcal toxic shock syndrome, although patients with necrotising fasciitis are at highest risk.

GAS is spread by close contact between individuals, through:

• respiratory droplets
• direct skin contact

It can also be transmitted environmentally, through:

• contact with contaminated objects, such as towels or bedding
• ingestion of food inoculated by a carrier

Invasive GAS (iGAS) infection and scarlet fever are both notifiable diseases: health professionals must inform local health protection teams of suspected cases. Guidelines are available for the public health management of iGAS cases in the community and healthcare settings and scarlet fever outbreaks in educational settings.

Diagnosis

GAS is usually diagnosed by microbiological culture of the affected site. Serology has specific clinical uses and can be discussed with a local infection specialist.

GAS isolates from patients with healthcare-associated infections should be stored locally for a minimum of 6 months.

• AMRHAI reference unit: reference and diagnostic services
  • 21 July 2021
  • Guidance

Management

See risk information for close community contacts of cases of iGAS infection.

Read further guidance on prevention and control of group A streptococcal infection in acute healthcare and maternity settings in the UK. Guidance on the management of close community contacts is provided below.

• Invasive group A streptococcal outbreaks: home healthcare
  • 9 September 2021
  • Independent report
• Invasive group A streptococcal disease: managing close contacts
  • 19 March 2008
  • Guidance
• Scarlet fever: managing outbreaks in schools and nurseries
  • 13 February 2018
  • Guidance

Epidemiology

Previous Group A streptococcal infections: activity reports were published by Public Health England.

• Pyogenic and non-pyogenic streptococcal bacteraemia: annual data from voluntary surveillance
  • 26 November 2021
  • Research and analysis
• Group A streptococcal infections: activity during the 2021 to 2022 season
  • 6 April 2022
  • Research and analysis

Published 31 July 2014
Last updated 6 April 2022 + show all updates

1. 6 April 2022

   Added Group A streptococcal infections: activity during the 2021 to 2022 season.

2. 9 September 2021

   Added link 'Invasive group A streptococcal outbreaks associated with home healthcare'.

3. 14 July 2021

   Updated link under Diagnosis to AMRHAI, which now provides diagnostic services.

4. 10 July 2019

   Added 'Group A streptococcal infections: activity during the 2018 to 2019 season' document.

5. 13 February 2018

   Latest seasonal activity document inserted into the Epidemiology subgroup (2017/2018 season)

6. 6 May 2016

   Added report on activity during the 2014 to 2015 season under epidemiology.

7. 2 December 2014

   Added 'Group A streptococcal infections: activity during the 2014 to 2015 season' to the collection.

8. 31 July 2014

   First published.