Collection

Group A Streptococcus

Information and guidance on group A streptococcal infections.

• From: UK Health Security Agency
• Published: 31 July 2014
• Last updated: 20 November 2023 — See all updates

This group A Streptococcus collection also contains information on:

Infection and symptoms

Group A Streptococcus (also known as GAS, group A strep, strep A, and Streptococcus pyogenes) is a bacterium which can colonise the throat, skin and anogenital tract. It is spread by close contact between individuals, through respiratory particles and direct skin contact. It can also be transmitted environmentally, for example through contact with contaminated objects, such as towels or bedding, or ingestion of food prepared by someone with the infection.

GAS causes a diverse range of skin, soft tissue and respiratory tract infections, including:

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

Occasionally these infections can be extremely severe.

Scarlet fever is characterised by a rash, which usually accompanies a sore throat. Cases may also have a red and swollen tongue and flushed cheeks.

Invasive GAS (iGAS) is another infection caused by GAS, that is much rarer than scarlet fever. It occurs when GAS is isolated from a normally sterile body site, such as the blood.

Both iGAS and scarlet fever are notifiable diseases; health professionals must inform local health protection teams (HPTs) of suspected cases.

Information for the public

Members of the public can seek advice about group A streptococcal infections from the following resources:

• NHS guidance on group A streptococcal infections
• NHS guidance for parents of babies or toddlers who may be seriously ill
• NHS guidance on looking after sick children
• Royal College of Paediatrics and Child Health (RCPCH) statement on group A streptococcal infections and scarlet fever

The latest UK Health Security Agency (UKHSA) updates for the public are also available on GOV.UK:

• UKHSA update on scarlet fever and invasive group A strep
• Group A strep - What you need to know

Guidance for professionals

Guidelines on antimicrobial prescribing for acute sore throat are set out in the National Institute for Health and Care Excellence (NICE) guidance [NG84]: Sore throat (acute): antimicrobial prescribing.

Due to rapidly increasing rates of GAS infections in children at the end of 2022, NHS England (NHSE) published interim clinical guidance on the diagnosis and treatment of children with GAS on 9 December 2022, which superseded the NICE guidance. In light of the decrease in rates of infection subsequently seen in early 2023, the NICE guidance has been reinstated and the interim guidance was withdrawn on 16 February 2023, as outlined in a statement from NHSE.

Prevention and control of group A streptococcal infection in acute healthcare and maternity settings in the UK was published in 2011 by the Health Protection Agency.

• Invasive group A streptococcal disease: managing close contacts in community settings
  • 7 March 2023
  • Guidance
• Scarlet fever: managing outbreaks in schools and nurseries
  • 3 April 2023
  • Guidance

Diagnosis

GAS is formally diagnosed by microbiological culture of samples taken from 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

Epidemiology and reports

Previous activity reports on group A streptococcal infections were published by Public Health England. The following are UKHSA reports:

• Group A streptococcal infections: report on seasonal activity in England, 2023 to 2024
  • 3 November 2023
  • Research and analysis
• Group A streptococcal infections: activity during the 2022 to 2023 season
  • 29 June 2023
  • Research and analysis
• Pyogenic and non-pyogenic streptococcal bacteraemia: annual data from voluntary surveillance
  • 22 November 2023
  • Research and analysis
• Group A streptococcal infections: activity during the 2021 to 2022 season
  • 20 September 2022
  • Research and analysis
• Invasive group A streptococcal outbreaks: home healthcare
  • 9 September 2021
  • Independent report

Published 31 July 2014
Last updated 20 November 2023 + show all updates

1. 20 November 2023

   Added Group A streptococcal infections: report on seasonal activity in England, 2023 to 2024.

2. 8 March 2023

   Updated guidance for professionals and added links to NICE guidelines on antimicrobial prescribing for sore throat and NHS England statement on withdrawal of interim guidance.

3. 16 December 2022

   Updated background information and provided links for people seeking medical advice.

4. 12 December 2022

   Added Group A streptococcal infections: activity during the 2022 to 2023 season.

5. 6 April 2022

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

6. 9 September 2021

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

7. 14 July 2021

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

8. 10 July 2019

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

9. 13 February 2018

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

10. 6 May 2016

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

11. 2 December 2014

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

12. 31 July 2014

    First published.