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Strep throat is unlikely when any of the symptoms of red eyes, hoarseness, runny nose, or mouth ulcers are present. It is also unlikely when there is no fever.[6]Strep throat is caused by group A beta hemolytic streptococcus (GAS or S. Pyogenes).[11] Other bacteria such as non group A beta hemolytic streptococci and fusobacterium may also cause pharyngitis.[8][10] It is spread by direct, close contact with an infected person; thus crowding, as may be found in the military and schools, increases the rate of transmission.[10][12] Dried bacteria in dust are not infectious, although moist bacteria on toothbrushes or similar items can persist for up to fifteen days.[10] Contaminated food can result in outbreaks, but this is rare.[10] Of children with no signs or symptoms, 12% carry GAS in their pharynx,[5] and, after treatment, approximately 15% of those remain positive, and are true "carriers".[13].

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