In Reply.—Dr Preston asks if I am suggesting that "the more symptoms a child has with a sore throat but a negative rapid GAS test, the more likely the concomitant throat culture will be negative for strep throat?" The answer is an unequivocal no. As stated by Behrman,1 "Conjunctivitis, rhinitis, cough and hoarseness occur rarely with proven streptococcal pharyngitis; and the presence of two or more of these signs or symptoms suggests the diagnosis of viral infection."
Dr Preston also asks "What, if anything, is the significance of fever in a child with a sore throat?" Commentaries in the third, fourth, and final paragraphs of my first letter indicate that fever was not a factor thought to aid in differentiating viral from streptococcal pharyngitis.
Last, Dr Preston asks why the "rapid GAS test" was used. The latex agglutination type of rapid GAS screening test was used because I