 The proposed study may answer the question whether this endogenous GAS origin represents chronic GAS carrier state, similar to the known GBS carrier state. As some of these patients had severe infections sometimes life threatening a protocol for long-term follow up and management is necessary in case an invasive procedure is done IUD insertion, endometrial biopsy, curettage or delivery in order to prevent recurrent infection. The information collected in the study will enable us to afford recommendations for follow up and prophylaxis in the future. 