Can Strep Throat in Adults Cause Rheumatic Heart Disease?
Yes, strep throat in adults can technically cause rheumatic heart disease, but initial attacks of acute rheumatic fever (which leads to rheumatic heart disease) are extremely rare in adults. 1
Key Epidemiological Facts
The risk profile differs dramatically between adults and children:
- Group A streptococcal pharyngitis causes only 5-10% of acute pharyngitis cases in adults, compared to 15-30% in children 1
- The risk of a first attack of acute rheumatic fever is extremely low in adults, even with untreated streptococcal pharyngitis 1
- Initial attacks of rheumatic fever are rare in adults, though recurrences in patients with prior rheumatic fever are well documented 1
Clinical Implications for Adults
Because of these epidemiological distinctions, the approach to diagnosis differs:
- Adults can be diagnosed with strep pharyngitis using rapid antigen detection testing (RADT) alone without backup throat culture confirmation (unlike children who require backup cultures for negative RADT results) 1
- This is acceptable specifically because the risk of subsequent rheumatic fever is so low in adults 1
When Adults Are at Higher Risk
Certain adult populations face elevated risk:
- Parents of school-aged children 1
- Adults whose occupation brings them into close association with children (teachers, healthcare workers, military recruits) 1, 2
- Individuals with a personal history of acute rheumatic fever (at risk for recurrence, not initial attack) 2
The Pathophysiology Connection
Untreated group A streptococcal pharyngitis is the precipitating cause of rheumatic fever, which can progress to rheumatic heart disease 1, 3, 4
- During historical epidemics, up to 3% of untreated streptococcal pharyngitis cases were followed by rheumatic fever 1
- Appropriate antibiotic treatment of streptococcal pharyngitis prevents acute rheumatic fever in most cases 1
- At least one-third of rheumatic fever episodes result from inapparent (asymptomatic) streptococcal infections 1, 2
Recent Case Evidence
A 2025 case report documented rheumatic myopericarditis in a 60-year-old adult following untreated streptococcal pharyngitis, demonstrating that while rare, this complication can still occur in adults in modern healthcare settings 5
Important Caveats
- Only pharyngeal streptococcal infections (not skin infections like impetigo) have been proven to lead to acute rheumatic fever 1
- The overall incidence of acute rheumatic fever remains very low in most areas of the United States currently 1
- Even with optimal treatment of streptococcal pharyngitis, rheumatic fever can still occur in susceptible individuals 2