Group A Streptococcal Pharyngitis Management in Pregnancy

Pathophysiology of Group A Streptococcal (GAS) Infection

Group A Streptococcus (GAS) is a bacterium causing pharyngitis (commonly known as strep throat), characterized by inflammation of the throat and tonsils. Infection manifests with symptoms such as sore throat, fever, headache, and sometimes body aches. GAS produces various toxins contributing to the disease's severity. In pregnant individuals, the risk of complications may be increased compared to non-pregnant populations.

Diagnosis of GAS Pharyngitis

Diagnosis typically involves a clinical examination assessing symptoms and a rapid antigen detection test (RADT) or throat culture. RADTs offer rapid results but may yield false negatives, necessitating throat culture for confirmation in cases of suspected infection despite a negative RADT. Accurate diagnosis is crucial for appropriate treatment.

Treatment Options During Pregnancy

Antibiotic treatment is essential for eradicating GAS infection and preventing potential complications such as rheumatic fever and post-streptococcal glomerulonephritis. Penicillin remains the antibiotic of choice, generally considered safe during pregnancy. Alternative antibiotics, such as amoxicillin or clindamycin, may be used in cases of penicillin allergy. Treatment duration is typically 10 days. The prescribing physician should carefully consider maternal and fetal safety when selecting and administering antibiotics.

Potential Complications During Pregnancy

Untreated GAS infection can lead to complications such as acute rheumatic fever, a serious inflammatory condition affecting the heart, joints, brain, and skin. Post-streptococcal glomerulonephritis, a kidney disorder, is another potential complication. These complications pose a greater risk to both the pregnant individual and the fetus. Early and appropriate treatment is vital in mitigating these risks.

Supportive Care Measures

In addition to antibiotics, supportive care measures can alleviate symptoms. These include adequate rest, increased fluid intake to prevent dehydration, and pain relief medication such as acetaminophen (paracetamol), which is generally considered safe during pregnancy when used as directed. Gargling with warm salt water may also provide temporary relief from throat discomfort.

Monitoring and Follow-up

Regular monitoring is essential to ensure effective treatment and detect any complications. Pregnant individuals should follow up with their healthcare provider for assessment of symptoms and to confirm treatment success. Any worsening symptoms or new concerning signs require immediate medical attention.

Preventive Measures

Good hygiene practices, such as frequent handwashing and avoiding close contact with infected individuals, can help prevent the spread of GAS. Vaccination against GAS is not currently available.