PT - JOURNAL ARTICLE AU - Himanshu Pathak AU - Tarnya Marshall TI - Post-streptococcal reactive arthritis: where are we now AID - 10.1136/bcr-2016-215552 DP - 2016 Aug 10 TA - BMJ Case Reports PG - bcr2016215552 VI - 2016 4099 - http://casereports.bmj.com/content/2016/bcr-2016-215552.short 4100 - http://casereports.bmj.com/content/2016/bcr-2016-215552.full AB - A 35-year-old man presented with polyarthritis and constitutional symptoms, and a recent history of multiple tick bites and skin rash on trekking holiday. He did not respond to oral doxycycline and cephalexine for presumed Lyme's disease. Further investigation confirmed strongly positive streptococcal serology. There was absence of clinical or echocardiography evidence of heart involvement and immunological screening for inflammatory arthritis was negative. In the absence of other major Jones criteria for acute rheumatic fever, besides polyarthritis and the serological evidence of a recent streptococcal infection, a diagnosis of post-streptococcal reactive arthritis (PSRA) was also made. He responded well to penicillin therapy and has been started on oral penicillin prophylaxis as per available guidance. As streptococcal infections in the adult population are increasingly reported, it is a timely opportunity to revisit PSRA, and develop comprehensive treatment and antibiotic prophylaxis guidelines.