What is the appropriate diagnosis and treatment for a patient presenting with a sore throat and swollen glands, whose partner has been diagnosed with strep throat?

Diagnosis and Treatment of Suspected Streptococcal Pharyngitis

For a patient with sore throat for 2 days, swollen glands, and known strep exposure, the appropriate ICD-10 code is J02.0 (Streptococcal pharyngitis), but testing should be performed before confirming this diagnosis and initiating treatment with amoxicillin.

Diagnostic Approach

• Testing for Group A Streptococcal (GAS) pharyngitis should be performed in this patient due to symptoms (sore throat, swollen glands) and exposure to a confirmed case (girlfriend with strep) 1
• The appropriate diagnostic test should be either a rapid antigen detection test (RADT) or throat culture 1
• A positive throat culture or RADT provides adequate confirmation of GAS in the pharynx 1
• If a RADT is performed and negative, it should be confirmed with a throat culture due to the lower sensitivity (80-90%) of RADTs compared to culture 1

Clinical Assessment

• Clinical features that suggest streptococcal pharyngitis include:
  • Fever (temperature >100.4°F/38°C)
  • Tonsillar exudates
  • Tender anterior cervical adenopathy (swollen lymph nodes)
  • Absence of cough 2
• The presence of cough, rhinorrhea (runny nose), hoarseness, and oral ulcers suggest viral etiology rather than streptococcal infection 1, 3
• Modified Centor criteria can help determine the likelihood of GAS infection and guide testing decisions 2

Treatment Recommendations

• If GAS pharyngitis is confirmed by testing, amoxicillin for 10 days is an appropriate treatment choice 1, 4, 5
• Amoxicillin is equally effective as penicillin for GAS pharyngitis and is often preferred in children due to better taste 2, 5
• The full 10-day course of antibiotic treatment is important to achieve maximal pharyngeal eradication of GAS and prevent complications 1, 4, 5
• For patients with penicillin allergy, alternatives include:
  • First-generation cephalosporins (for non-anaphylactic allergy)
  • Clindamycin, clarithromycin, or azithromycin (for anaphylactic allergy) 1, 2

Important Considerations

• Treatment should not be initiated before testing unless there is a very high clinical suspicion 1
• Antibiotics shorten symptom duration by only 1-2 days but can prevent complications such as peritonsillar abscess and acute otitis media 2
• Patients are no longer contagious after 24 hours of appropriate antibiotic therapy 4
• Follow-up throat cultures after treatment completion are not routinely recommended for asymptomatic patients 1, 4

Common Pitfalls to Avoid

• Treating without testing - most cases of sore throat are viral, not bacterial 2
• Using broad-spectrum antibiotics unnecessarily when narrow-spectrum options are effective 2
• Prescribing antibiotics for asymptomatic carriers of GAS 3
• Not completing the full 10-day course of antibiotics, which can lead to treatment failure and complications 1, 4

ICD-10 Coding

• If strep test is positive: Use J02.0 (Streptococcal pharyngitis)
• If strep test is negative or pending: Use J02.9 (Acute pharyngitis, unspecified) until confirmed
• If influenza is also present as mentioned in the question, additional influenza codes (J09-J11 series) would be appropriate based on the specific type