Group A streptococcal (Streptococcus pyogenes) infections remain important causes of medical and public health morbidity and mortality even during the early twenty-first century. Although most often concentrated in socially/economically disadvantaged populations, the problems remain significant in both industrializing and industrialized countries. The many M/emm types of GAS contribute to herd immunity in populations and also affect the control of streptococcal infections in these populations. Although this bacterium remains among the most susceptible to most antibiotics, it is evident that antibiotics alone have not solved the group A streptococcal medical and public health problems, even in those places where access to medical care is readily available. It is likely that the current streptococcal problems will remain difficult to manage and will remain essentially unchanged until the broad implementation of a cost-effective group A streptococcal vaccine, likely some years in the future.