Classic signs and symptoms of group A Streptococcus pharyngitis include abrupt onset, high fever, sore throat, tonsillar or pharyngeal exudates, headache and myalgia.  Group A beta-hemolytic induced Streptococcal pharyngitis is unlikely in the presence of cough, runny nose, conjunctivitis or hoarse voice.  Occasionally you may see a group C Strep causing these symptoms, but it is group A that causes the worrisome complications of post-Strep glomerulonephritis, scarlet fever, endocarditis, and rheumatic fever.  Classic age range is children and adolescents ages 5-15.  Adults, especially older adults, rarely get group A beta-hemolytic Streptococcal pharyngitis.  If you commonly think a 40 year old patient is going to have strep throat, though possible, you’re going to be wrong much more than you are going to be right.  Palatal petechiae will often lock in your diagnosis, if present, and accompanied by the above classic symptoms.  Treatment remains oral penicillin V.