Perianal streptococcal cellulitis

Perianal streptococcal cellulitis usually occurs in children. It often appears during or after strep throat, nasopharyngitis, or streptococcal skin infection (impetigo).

The skin around the anus may get infected while a child wipes the area after using the toilet. The infection can also result from scratching the area with fingers that have bacteria from the mouth or nose.

Symptoms may include:

• Fever
• Itching, pain, or bleeding with bowel movements
• Redness around the anus

Your health care provider will examine the child and ask about the symptoms.

Tests that may be done include:

• Rectal swab culture
• Skin culture from rectal area
• Throat culture

The infection is treated with antibiotics for about 10 days, depending on how well and quickly they are working. Penicillin is the most often used antibiotic in children.

Topical medicine can be applied to the skin and is commonly used with other antibiotics, but it should not be the only treatment. Mupirocin is a common topical medicine used for this condition.

Children usually recover quickly with antibiotic treatment. It is important to contact your provider if your child does not get better soon on antibiotics.

Complications are rare, but may include:

• Anal scarring, fistula, or abscess
• Bleeding, discharge
• Bloodstream or other streptococcal infections (including heart, joint, and bone)
• Kidney disease (acute glomerulonephritis)
• Severe skin and soft tissue infection (necrotizing fasciitis)

Contact your child's provider if your child complains of pain in the rectal area, painful bowel movements, or other symptoms of perianal streptococcal cellulitis.

If your child is taking antibiotics for this condition and the area of redness gets worse, or the discomfort or fever is increasing, contact your provider immediately.

Careful handwashing may help prevent this and other infections caused by bacteria carried in the nose and throat.

To prevent the condition from coming back (relapse), be sure your child finishes all the medicine the provider prescribes.

Streptococcal proctitis; Proctitis - streptococcal; Perianal streptococcal dermatitis

Paller AS, Mancini AJ. Bacterial, mycobacterial, and protozoal infections of the skin. In: Paller AS, Mancini AJ, eds. Paller and Mancini - Hurwitz Clinical Pediatric Dermatology. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Shulman ST, Patel AB. Group A streptococcus. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 229.

Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.