[1] The diagnosis of perianal cellulitis is made either through a rapid strep test or by swabbing the affected areas for a bacterial culture indicating infection by group A β-hemolytic streptococci.

[1][11] In order to confirm diagnosis of perianal streptococcal dermatitis, the anus and genitalia require examination followed by bacterial swabbing of the exudate from the affected area is preferred.

"[1] Because perianal cellulitis is commonly misdiagnosed, it is imperative that the proper diagnosing procedures are followed when encountering these symptoms, as delayed detection can result in severe complications.

[2] Across the different disciplines of care, nurses have an opportunity to provide education on proper hygiene techniques to reduce the risk of recurrent infection.

[2] By working together as an inter-professional team, all types of clinicians can improve patient health outcomes by raising awareness and reducing both time to diagnosis and the rate of recurrence of perianal streptococcal dermatitis infection.

In most cases of perianal streptococcal dermatitis in children, swab cultures indicate that infection is caused by the bacteria Streptococcus pyogenes, more specifically classified as group A beta-hemolytic streptococci (GAS).

[13][8] It is important to note, however, that in the rare adult cases of perianal streptococcal cellulitis that have been identified, the most common cause is by beta-hemolytic streptococci from group B specified as Streptococcus agalactiae.

Group B streptococcus is more commonly found in the gastrointestinal and genital tracts, and can also be transmitted vertically from mother to child during vaginal labor.

Failure to properly diagnose and treat perianal streptococcal dermatitis may lead to more serious infections that could result in injury or death.

An adhesin found in group A beta-hemolytic streptococci of particular importance is called the M protein, which utilizes complex mechanisms to recognize various receptors on human cell types for attachment.

[17] After attachment, colonization of Streptococcus pyogenes occurs and the bacteria release many toxins that are responsible for the manifestation of symptoms of perianal cellulitis such as inflammation, fever, and itching.

[19][6] As the streptococci continue to colonize, the formation of a biofilm may arise and its protective properties may make it more difficult to treat the infection with antibiotics.

[21] After the diagnosis of perianal streptococcal dermatitis has been confirmed, the most successful treatment regimens utilize a combination of topical and systemic antibiotics.

However, "approximately one-third of people with cellulitis suffer recurrent episodes and the only proven strategy for preventing this is long-term, low-dose oral penicillin.

"[12] Performing post-treatment swabbing and confirming eradication of group A β-hemolytic streptococci infection reduces the chance of perianal streptococcal dermatitis recurrence.

[1] Results from a systematic literature review further supports this as a majority of childhood cases of perianal streptococcal cellulitis occurred in males younger than 7 years old.