One of the joys of being a physician is treating family members over the phone. For the past two weeks, I've done my best to help a family member 3000 miles away with rectal itching. Amid phone calls about "my hiney hole" ... we've run through the list of disorders that could be causing the problem. The note home from the kids' school about pinworm turned out to be a red herring .. as the course of mebendazole didn't help much, and the stool was negative for parasites.
And so this went on-and-on. Her physician (an internist) diagnosed hemorrhoids .. but treatment didn't help at all. ?A fungal infection? The physician tried antifungals. No change ... it even seemed a bit worse.
Weeks pass .. and still no resolution. I start to try to learn about the physical signs. The husband gets involved.. he reports a bright red area around the anus.
She's got two kids - 6 and 4. Hmmm ... the only thing I can think of that hasn't been considered is GABHS. I haven't seen "strep butt." in an adult .. but kids do get it .. and I see a few cases of it every year. Could this 36 year old mother-of-two-likely-strep-vectors get it? I don't see why not. I suggest this .. and suggest that she get a strep culture (or even a rapid test) from her physician.
End of long story: after working (very) hard to convince her physician (who had never heard of perianal strep) that this was a reasonable diagnostic test .. my relative received a phone call today from her very surprised physician - "very heavy GABHS."
While reasonably common in children, now we all know GABHS can be seen in adults too.