Group A Streptococcal Carrier State

Sir.—Gerber et al¹ raise important issues pertaining to identification of the group A streptococcal (GAS) carrier state. We agree that antistreptococcal antibody titers are of little value in distinguishing GAS carriers with intercurrent viral pharyngitis from patients with acute GAS infection. In addition to data presented by Gerber and colleagues, there is additional evidence that antibiotic therapy may blunt the immune response to bona fide GAS infection.^2,3

Because we believe that in some circumstances there may be benefit to identifying and terminating the carrier state, we have considered various criteria to define chronic GAS carriage.⁴ In our treatment studies of such carriers, we have used a simple operational definition of GAS carriage that does not depend on assessment of serologic responses.^4,5 We define a patient as a carrier if the patient is asymptomatic and the throat culture is still positive for group A streptococci three