ObjectiveAntibiotic treatment of Group A Streptococcus (GAS) pharyngitis is important in acute rheumatic fever (ARF) prevention, however clinical guidelines for prescription vary. GAS carriers with acute viral infections may receive antibiotics unnecessarily. This review assessed the prevalence of GAS pharyngitis and carriage in different settings.MethodsA random-effects meta-analysis was performed. Prevalence estimates for GAS+ve pharyngitis, serologically-confirmed GAS pharyngitis and asymptomatic pharyngeal carriage were generated. Findings were stratified by age group, recruitment method and country income level. Medline and EMBASE databases were searched for relevant literature published between 1 January 1946 and 7 April 2017. Studies reporting prevalence data on GAS+ve or serologically-confirmed GAS pharyngitis that stated participants exhibited symptoms of pharyngitis or upper respiratory tract infection (URTI) were included. Included studies reporting the prevalence of asymptomatic GAS carriage needed to state participants were asymptomatic.Results285 eligible studies were identified. The prevalence of GAS+ve pharyngitis was 24.1% (95% CI: 22.6–25.6%) in clinical settings (which used ‘passive recruitment’ methods), but less in sore throat management programmes (which used ‘active recruitment’, 10.0%, 8.1–12.4%). GAS+ve pharyngitis was more prevalent in high-income countries (24.3%, 22.6–26.1%) compared with low/middle-income countries (17.6%, 14.9–20.7%). In clinical settings, approximately 10% of children swabbed with a sore throat have serologically-confirmed GAS pharyngitis, but this increases to around 50–60% when the child is GAS culture-positive. The prevalence of serologically-confirmed GAS pharyngitis was 10.3% (6.6–15.7%) in children from high-income countries and their asymptomatic GAS carriage prevalence was 10.5% (8.4–12.9%). A lower carriage prevalence was detected in children from low/middle income countries (5.9%, 4.3–8.1%).ConclusionsIn active sore throat management programmes, if the prevalence of GAS detection approaches the asymptomatic carriage rate (around 6–11%), there may be little benefit from antibiotic treatment as the majority of culture-positive patients are likely carriers.

transmitted sexually. To date, sustained chains of ZIKV within sexual networks, as observed in many sexually transmitted infections (STIs), have not been described. Here, the risk of sustained spread of ZIKV in England by sexual transmission is assessed.Methods & Materials: Due to the dearth of information on sexual transmission of ZIKV, national experts on emerging infections, flaviviruses and STIs were consulted by questionnaire for their consensus opinion on the possibility of tertiary and sustained sexual transmission of ZIKV and its potential impact. These opinions and compiled case data were used to qualitatively assess the risk of sustained sexual transmission of ZIKV within England.Results: People in monogamous partnerships as well as those in heterosexual or lesbian partnerships were evaluated as having an exceptionally low risk of initiating tertiary sexual transmission. In contrast, the risk of tertiary transmission within populations of men who have sex with men (MSM) was assessed as dependent on sexual behaviour. The highest risk group was the subset of MSM in dense sexual networks of multiple concurrent sexual partners, a known risk group for outbreaks of emerging sexually transmitted infections such as lymphogranuloma venereum. However, the risk of such an event occurring within this high risk network in England was assessed as very low, as it is predicated on engagement in high risk activity during semen ZIKV positivity. Importantly, the risk of congenital infections from sustained chains of sexual transmission was assessed as exceptionally low as most MSM in these networks are thought to exclusively have male partners. Conclusion:There is a theoretical possibility of sustained chains of sexual transmission of ZIKV however; the risk of such an event was assessed as very low. Nevertheless, advice on reducing the risk of sexual transmission of ZIKV should be targeted at all sexually active individuals, regardless of sexual orientation and behaviour.

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