A rapid strep test was negative in a 12-year-old girl with tonsillar exudate, fever, and sore throat. Which statement is true regarding this?

A rapid strep test was negative in a 12-year-old girl with tonsillar exudate, fever, and sore throat. Which statement is true regarding this?

• A. A throat swab should be collected and sent to microbiology
• B. A rapid strep test should be repeated
• C. The patient does not have Strep throat
• D. The patient probably has mononucleosis

Answer: (A)

A negative rapid strep test does not completely rule out strep throat in a child who has a fever and tonsillar exudates. Rapid tests are highly specific but not perfectly sensitive, so some true GAS infections are missed. The best next step is to obtain a throat swab for culture, which is more sensitive and can confirm whether Strep pyogenes is present. If the culture grows GAS, treat accordingly; if it’s negative, GAS is unlikely and you can pursue other diagnoses. Repeating the rapid test isn’t usually helpful, and while mononucleosis can present with sore throat and exudates, the appropriate action here is culture to confirm GAS.

A negative rapid strep test does not completely rule out strep throat in a child who has a fever and tonsillar exudates. Rapid tests are highly specific but not perfectly sensitive, so some true GAS infections are missed. The best next step is to obtain a throat swab for culture, which is more sensitive and can confirm whether Strep pyogenes is present. If the culture grows GAS, treat accordingly; if it’s negative, GAS is unlikely and you can pursue other diagnoses. Repeating the rapid test isn’t usually helpful, and while mononucleosis can present with sore throat and exudates, the appropriate action here is culture to confirm GAS.