<P> The Infectious Disease Society of America recommends against empirical treatment and considers antibiotics only appropriate when given after a positive test . Testing is not needed in children under three as both group A strep and rheumatic fever are rare, unless a child has a sibling with the disease . </P> <P> A throat culture is the gold standard for the diagnosis of streptococcal pharyngitis, with a sensitivity of 90--95% . A rapid strep test (also called rapid antigen detection testing or RADT) may also be used . While the rapid strep test is quicker, it has a lower sensitivity (70%) and statistically equal specificity (98%) as a throat culture . In areas of the world where rheumatic fever is uncommon, a negative rapid strep test is sufficient to rule out the disease . </P> <P> A positive throat culture or RADT in association with symptoms establishes a positive diagnosis in those in which the diagnosis is in doubt . In adults, a negative RADT is sufficient to rule out the diagnosis . However, in children a throat culture is recommended to confirm the result . Asymptomatic individuals should not be routinely tested with a throat culture or RADT because a certain percentage of the population persistently "carries" the streptococcal bacteria in their throat without any harmful results . </P> <P> As the symptoms of streptococcal pharyngitis overlap with other conditions, it can be difficult to make the diagnosis clinically . Coughing, nasal discharge, diarrhea, and red, irritated eyes in addition to fever and sore throat are more indicative of a viral sore throat than of strep throat . The presence of marked lymph node enlargement along with sore throat, fever, and tonsillar enlargement may also occur in infectious mononucleosis . </P>

Where is strep throat most likely to be found in the world