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Group A Strep

Checked: 26-04-2024 by 5 Rob Adams Next Review: 23-04-2026


For management of suspected or confirmed Group A Streptococcus please see:

For antimicrobial management of sore throat and scarlet fever please see BNSSG Primary Care Antimicrobial Guidelines on the following page:

Please note scarlet fever/ group A strep is a notifiable disease.



****STOP PRESS**** April 2024

There has been cluster of confirmed cases of invasive Group A Streptococcal infection (iGAS) in people in People Who Inject Drugs (PWID) in central Bristol. Please see the Health Security Agency letter.for details.

Red Flags

Invasive GAS (iGAS) is another infection caused by GAS, that is much rarer than scarlet fever. It occurs when GAS is isolated from a normally sterile body site, such as the blood (2).

Occasionally these infections can be extremely severe.

People at increased risk of Invasive Group A Strep (iGAS)

  • At extremes of the age range, such as the very young and old, or postpartum women.
  • Who are immunocompromised, immunosuppressed, or with other comorbidities.
  • With concurrent chickenpox or influenza.
  • Who inject drugs or are alcohol dependent.

Management of Suspected Invasive Group A Strep (iGAS)

If there are symptoms/signs of Sepsis then direct patient to:

Scarlet Fever

Scarlet fever is an infectious disease caused by Group A Strep (GAS) and is  mainly a childhood disease, with around 90% of cases occurring in children under 10 years old. People of all ages can also catch scarlet fever, but the disease is much less common in adults (1).

Please see the Scarlet Fever/ Group A Strep (children and young people) page for further information.


(1) Scarlet fever: symptoms, diagnosis and treatment - GOV.UK (

(2) Group A Streptococcus - GOV.UK (

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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