ARF can lead to rheumatic heart disease, disability, open heart surgery and death, especially when recurrent episodes occur. ARF and RHD are prevalent in children and young adults in the Northern Territory. They are caused by Strep A (Streptococcus pyogenes) infection of the throat and skin. Aboriginal and Torres Strait Islander populations are at high risk, but also consider the diagnosis in other population groups including migrants and Pacific Islanders. The management of pharyngitis and skin sores is different in the Northern Territory. Do not use the approach which is appropriate for southern states. The clinical decision rules to differentiate between viral and bacterial pharyngitis do not apply in communities with very high rates of Strep A infection.