Repetition of the rapid antigen test in initially negative supposed streptococcal pharyngitis is not necessary in adults

Summary Aims: To determine whether the repetition of the rapid antigen detection test (RADT) in patients, with a high suspicion of presenting pharyngitis by group A β‐haemolytic streptococci (GABHS), with a previously negative test improves the validity of the test. Methods: Two hundred and twenty‐two patients aged 14 years or more with acute pharyngitis and two or more Centor criteria – tonsillar exudates, fever, tenderness in the lymph glands and/or absence of cough – were consecutively recruited. In all patients, a pharyngotonsillar sample was obtained with two swabs, one for the RADT (OSOM® Strep A Genzyme test, Genzyme Diagnostics, Cambridge, MA, USA) and the other was sent to the Department of Microbiology for culture. In patients with a negative RADT, the determination was repeated. The sensitivity, specificity and predictive values were determined. Results: Cultures were positive for GABHS in 55 patients (24.8%). Three false‐negatives and 14 false‐positives were observed by comparing the rapid test with throat culture, achieving a sensitivity of 94.5% and a specificity of 91.6%. Positive and negative predictive values were 78.8% and 98.1% respectively. Taking the second determination in the negative cases into account, the results were 96.4%, 91.6%, 79.1% and 98.7% respectively. Conclusions: The negative predictive value achieved with the RADT determination was very high. Repetition of the test only slightly improved this percentage, making repetition of this test unnecessary.