Perianal Strep Infection

Naturally, we are all accustomed to evaluating children for rashes. Most often I am simply attempting to define the lack of characteristics that are concerning for more significant medical conditions (petechiae, purpura, vesicles, bull, target lesions, urticaria, desquamation). Then I consider whether this is a presentation of typical childhood illness (Fifth’s Disease, molluscum contagiosum, pityriasis rosea, etc). Here is a condition that is often forgotten about that you can add to your list of typical childhood rashes… one that many times gets overlooked and called “diaper rash:” Perianal Strep.

  • Usually occurs in children <10 years of age – particularly infants and pre-school aged kids.
  • Group A Streptococcus pyogenes (Yes the same that causes “Strep Throat”) can cause local skin infection in the perianal region (just as it can in skin folds – see Intertrigo).
  • Presentation includes:
    • Well-demarcated red area surrounding the anus (usually “Beefy-red” and usually extending 2cm around the anus) – sometimes with exudates
    • Tenderness
    • Painful defecations (leading to constipation due to toileting aversion)
    • Itching
    • Fissures
    • Bloody streaks in stool
    • Vulvovaginits
  • Often misdiagnosed as:
    • Pin-worm infection
    • Candidiasis
    • Diaper Dermatitis
    • Simple anal fissures
    • Sexual abuse
  • You can diagnosis it as you would Strep Throat – with a Rapid Strep test and a Culture
  • Treatment:
    • Oral Penicillin VK or Clarithromycin or Augmentin for 7-10 days.
    • The efficacy of topical therapies is questionable.


Lehman R, Pinder S. Streptococcal perianal infection in children. BMJ 2009; 338:b1517

Echeverria FM, Lopez-Menchero OJ, Maranon PR, Miguez NC, Sanchez SC, Vasquez LP. Isolation of group A hemolytic streptococcus in children with perianal dermatitis. An Pediatr (Barc) 2006;64:153-7.

Sean M. Fox
Sean M. Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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