Research on the Gram-positive human-restricted pathogen Streptococcus pyogenes (Group A Streptococcus, GAS) has long focused on invasive illness, the most severe manifestations of GAS infection. Recent advances in descriptions of molecular mechanisms of GAS virulence, coupled with massive sequencing efforts to isolate genomes, have allowed the field to better understand the molecular and evolutionary changes leading to pandemic strains. These findings suggest that it is necessary to rethink the dogma involving GAS pathogenesis, and that the most productive avenues for research going forward may be investigations into GAS in its ‘normal’ habitat, the nasopharynx, and its ability to either live with its host in an asymptomatic lifestyle or as an agent of superficial infections. This review will consider these advances, focusing on the natural history of GAS, the evolution of pandemic strains, and novel roles for several key virulence factors that may allow the field to better understand their physiological role.

革兰氏阳性人类限制性病原体化脓性链球菌（A群链球菌）的研究（GAS）长期以来一直专注于侵入性疾病，这是GAS感染的最严重表现。在描述GAS毒力的分子机制方面的最新进展，加上为分离基因组进行大规模测序的努力，已使该领域更好地了解了导致大流行毒株的分子和进化变化。这些发现表明，有必要重新考虑涉及GAS发病机理的教条，而进行研究最有效的途径可能是对GAS在其“正常”栖息地，鼻咽及其与宿主共同生活的能力进行调查。无症状的生活方式或浅表感染的媒介。这篇评论将考虑这些进展，重点是GAS的自然历史，大流行毒株的演变，