Perianal strep is a bacterial skin infection affecting the area around the anus. Caused by Streptococcus pyogenes, the same bacteria responsible for strep throat, it is more frequently observed in children, though adults can also be affected. The infection is treatable with medical care.
Understanding Perianal Strep
Perianal strep is an infection of the skin surrounding the anus and rectum. It is caused by Group A Streptococcus (Streptococcus pyogenes), which can also cause strep throat and impetigo. The infection often occurs through self-inoculation, where an individual touches the anal area after coming into contact with strep bacteria from their mouth or nose, or another infected area of the skin. It can also spread through close contact with an infected person. Toddlers and young children are commonly affected, perhaps due to less developed hygiene practices.
Recognizing the Symptoms
Symptoms typically appear around the anus. A bright red, sharply demarcated rash is a common sign, often appearing more intense and moist than a typical diaper rash. This redness may extend approximately 2-3 cm around the anus and can sometimes spread to the genital area.
Individuals frequently experience itching and pain in the affected region. Pain during bowel movements is also common and may lead to constipation as children might try to avoid defecation due to discomfort. Blood-streaked stools or anal fissures can also be present. Fever is usually absent or mild.
Diagnosis and Treatment Approaches
Diagnosis involves a physical examination and laboratory tests. A healthcare provider examines the affected area for the characteristic bright red, well-demarcated rash. A bacterial culture from a perianal swab confirms the diagnosis by identifying Group A Streptococcus. Rapid strep tests can also be used, but a culture provides definitive confirmation.
Treatment involves oral antibiotics, such as penicillin or amoxicillin, often prescribed for children. The usual duration is 10 days, though longer courses may be prescribed to prevent recurrence. It is important to complete the entire course of antibiotics to ensure the infection is fully eradicated and prevent recurrence.
For penicillin allergies, alternative antibiotics like erythromycin, azithromycin, or clindamycin may be prescribed. Supportive care, such as sitz baths in warm water after bowel movements, can help alleviate pain and itching. Topical mupirocin may be used as an additional treatment.
Prevention and When to Seek Medical Help
Prevention involves good hygiene practices. Thorough handwashing with soap and water is important, especially after using the restroom or touching the affected area. Children should be encouraged to scrub under their fingernails to remove any lingering bacteria. To prevent the spread of the infection within a household, avoid sharing towels or bathwater.
Seek medical attention for a persistent bright red rash around the anus, especially if it does not improve with typical diaper rash treatments or if it is accompanied by pain or itching. Consult a doctor if there is pain during bowel movements, blood in the stools, or if the rash changes, worsens, or spreads. Prompt diagnosis and treatment are important, particularly if there is a known strep throat infection in the household, as perianal strep can sometimes occur in conjunction with or after other streptococcal infections.