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Streptococcal infections (Strep A) in primary care settings

02 July 2023
Volume 34 · Issue 7


In December 2022, there was a reported increase in the number of infections in the UK, resulting in deaths of young children, occurring as a result of invasive Strep A infections. Margaret Perry explains how these infections can be managed in a general practice setting.

Group A streptococcal infections (GAS) are reported to be common and are often carried on the skin or in the throat and are harmless. However, in some cases they cause infection which may be mild, or in some cases the problem becomes invasive (iGAS) resulting in a more serious infection requiring hospital admission and treatment. This article will give an overview of the commonest infections arising as a result of GAS and will look at signs and symptoms, treatment, and complications, with the aim of increasing confidence among practice nurses and non-medical prescribers in the recognition and management of these conditions.

Group A streptococcus, commonly abbreviated to GAS or Strep A, is a common bacterium often found on the skin or in the throat and usually causes no problems. However, there is an association with several infections, some mild, some more severe, the most serious of these caused by an invasive group of Strep A bacteria known as iGAS (UK Health Security Agency 2022). Whilst iGAS infections are still uncommon, there has been an increase in cases this year, particularly in children under 10 and sadly, these have resulted a small number of deaths (UK Health Security Agency 2022). The increased incidence is of concern to clinicians in General Practice and this article therefore hopes to give nurses and non-medical prescribers more information and increased confidence in recognising symptoms of concern and getting early treatment, and hopefully preventing more serious consequences.

Infections caused by Strep A typically come in waves and in previous years outbreaks have occurred around March to April (McKechnie 2022). However, in December 2022, there was a reported increase in the number of infections in the UK, resulting in deaths of young children, occurring as a result of invasive infections (UK Health Security Agency 2022). In particular, there has been a steep increase in scarlet fever and GP consultations for this disease, occurring early in the 2022 to 2023 season, and these have been greater than would be expected at this time of the year (GOV UK 2022). In children below the age of 10, the rate of iGAS infections has been substantially higher in the past 2 years, a problem currently under investigation following reports of an increase in lower respiratory tract and empyema Gas infections, (GOV UK 2023).

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