Streptococcal Perianal Disease
Group A 
-hemolytic streptococcus caused perianal disease in children 1 to 10 years of age in two reported series of 31 and 11 cases. Signs and symptoms were perianal itching (78%), rectal pain (52%), and blood-streaked stools (35%). Systemic symptoms or perianal cellulitis were not observed in these 42 cases.
In the study reported by Kokx, concurrent pharyngeal colonization was found in 64% of cases, and clinical pharyngitis was found in only 13%. It is unclear whether perianal streptococcal disease precedes or follows pharyngeal colonization. Intrafamilial spread of perianal disease was reported, but communal bathing was not found to be a statistically significant factor.
