Streptococcal infections spread readily by respiratory droplets generated by yelling, coughing, and sneezing, especially in the range of about 2 to 5 feet from an infected individual. If strep throat is untreated, the person may be an asymptomatic carrier for weeks. People who carry the organism in their nose spread the streptococci more effectively than do pharyngeal carriers. Anal carriers are not common but can be a dangerous source of nosocomial infections. Epidemics of strep throat can originate from food contaminated by S. pyogenes carriers. Some people become long-term carriers of S. pyogenes. In these cases, the infecting strain usually becomes deficient in M protein and is not a threat to the carrier or to others. The peak incidence of strep throat occurs in winter or spring and is highest in grade school children. Among students visiting a clinic because of sore throat at a large West Coast university, less than 5% had strep throat. With some groups of military recruits, however, the incidence has been above 20%.
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