Although S. pyogenes remains universally sensitive to β-lactam, macrolide- and lincosamide-resistance frequently result in recurrent infection, treatment failure and poor patient outcomes.5 Genotyping of the emm gene encoding the cell-surface M protein is usually applied to clinical S. pyogenes isolates obtained from patients.6 The predominant emm types found in STSS are 1, 89, 12 and 3 (arranged in descending order of prevalence), and account for more than 70% of the STSS isolates in Japan. The gene discussed is PIGG; the disease is infection.