What is your approach to determining whether a patient who repeatedly tests positive for strep has reinfection or has asymptomatic carriage?

One of the biggest challenges is that there is no single test that reliably distinguishes recurrent Group A Streptococcus (GAS) infection from chronic asymptomatic carriage. My approach starts with the clinical history. Patients with true recurrent GAS typically have the classic syndrome, e.g., abru...