A patient with sore throat and fever has exudates; rapid strep test is negative. What is the most appropriate next step?

• A. Throat culture
• B. Supportive measures
• C. Both B & C
• D. Antibiotics

Answer: (C)

A negative rapid strep test does not completely rule out group A streptococcal pharyngitis when clinical signs suggest it. The rapid test is very specific but can miss infections because its sensitivity is not perfect. With a patient who has sore throat, fever, and exudates, the pretest probability for GAS is still meaningful, so the next step is to obtain a throat culture. The culture has higher sensitivity and serves as the definitive test in this scenario. If the culture grows GAS, treat with a first-line antibiotic such as penicillin or amoxicillin; if the culture is negative, antibiotics aren’t indicated and supportive care is appropriate. Starting antibiotics based solely on symptoms after a negative rapid test risks unnecessary treatment, while relying on supportive care alone could miss a GAS infection that would benefit from antibiotic therapy.