ARF can lead to rheumatic heart disease, disability, open heart surgery and death. ARF and RHD are prevalent in children and young adults in Queensland. They are caused by Strep A (Streptococcus pyogenes) infection of the throat and skin. Clinical differentiation and management of viral and bacterial pharyngitis is specialised in high risk groups in communities with very high rates of Strep A infection. High risk populations include Aboriginal and Torres Strait Islanders, Maoris, refugees, migrants from developing countries and Pacific Islander populations. The management of pharyngitis and skin sores is different in these populations. Do not use the approach which may be appropriate in mainstream practice.