The absence of fever, tonsillar swelling and exudate, and anterior cervical adenopathy and the presence of rhinorrhea and cough all pointed to a viral upper respiratory infection. The red spots were palatal petechiae, which are seen in all types of pharyngitis and are benign.
Testing for strep pharyngitis is unnecessary. Treatment is directed at the symptoms only.
The treatment for most cases of non-group A β-hemolytic Streptococcus (GABHS) pharyngitis includes education. Explain to patients the difference between a viral and a bacterial infection to help them understand why antibiotics are not being prescribed.
Studies have demonstrated that spending time with patients to explain the disease process is associated with greater patient satisfaction than prescribing an antibiotic. Fortunately, this patient was not seeking antibiotics and was happy to hear that the viral infection was self-limited. The family physician recommended analgesics as needed, plenty of fluids, and moderate rest.
Photo and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Williams, B, Usatine R, Smith M. Pharyngitis. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:213-219.
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