Physical Examination Findings for Strep Throat
The key physical examination findings for strep throat include tonsillopharyngeal erythema with or without exudates, tender enlarged anterior cervical lymph nodes, palatal petechiae, and a beefy red swollen uvula. 1
Classic Clinical Findings
- Tonsillopharyngeal inflammation (erythema) is a hallmark finding in streptococcal pharyngitis 1
- Patchy tonsillopharyngeal exudates may be present but are not required for diagnosis 1
- Tender, enlarged anterior cervical lymph nodes (lymphadenitis) are commonly found 1
- Palatal petechiae ("doughnut lesions") are highly suggestive of strep throat when present 1
- Beefy red, swollen uvula is another characteristic finding 1
- Scarlatiniform rash may be present in some cases (scarlet fever) 1
- Excoriated nares may be seen, especially in infants 1
Associated Systemic Findings
- Fever, typically ranging from 101°F to 104°F 1
- Headache is commonly reported 1
- Nausea, vomiting, and abdominal pain may be present, especially in children 1
Distinguishing from Viral Pharyngitis
Physical examination findings that suggest a viral rather than streptococcal etiology include:
- Conjunctivitis 1
- Coryza (nasal discharge) 1
- Cough 1, 2
- Hoarseness 1
- Discrete ulcerative stomatitis (mouth ulcers) 1
- Viral exanthem (characteristic rash) 1
- Diarrhea 1, 2
Diagnostic Challenges
- None of the clinical findings, individually or collectively, is specific enough to definitively diagnose streptococcal pharyngitis without laboratory confirmation 1
- Even experienced clinicians cannot reliably distinguish streptococcal from viral pharyngitis based solely on physical examination 1
- Clinical scoring systems (like the modified Centor score) that incorporate physical exam findings can help determine which patients need testing or empiric therapy 3, 2
Age-Related Considerations
- Strep throat primarily affects children between 5 and 15 years of age 1
- In children younger than 3 years, classic findings may be less apparent 1
- Infants with Group A streptococcal infections may present with excoriated nares or purulent nasal discharge rather than classic pharyngitis 1
Seasonal and Epidemiological Context
- Physical findings are more likely to represent strep throat when presenting in winter or early spring in temperate climates 1
- A history of exposure to a documented case of streptococcal pharyngitis increases the likelihood that physical findings represent strep throat 1
Remember that microbiological confirmation with either throat culture or rapid antigen detection testing is required for definitive diagnosis, as physical examination alone cannot reliably distinguish streptococcal from viral pharyngitis 1.