Adding to this, bacteria can form biofilms that are undetectable with blood tests. This is thought to be one way that streptococcal bacteria such as _S. pyogenes_ can stay around in the body for a long time, perhaps indefinitely [1].
These biofilms become microcolonies of bacteria (in places such as in the tonsils) that can lie dormant and reinfect in cycles. People who experience recurring strep infections (i.e. strep throat or strep tonsillitis) are often advised to get a tonsillectomy.
Additionally, strep is thought to be capable of inducing autoimmunity through a mechanism called molecular mimicry [2], and this mechanism been implicated in several diseases, including rheumatic fever and psoriasis.
These biofilms become microcolonies of bacteria (in places such as in the tonsils) that can lie dormant and reinfect in cycles. People who experience recurring strep infections (i.e. strep throat or strep tonsillitis) are often advised to get a tonsillectomy.
Additionally, strep is thought to be capable of inducing autoimmunity through a mechanism called molecular mimicry [2], and this mechanism been implicated in several diseases, including rheumatic fever and psoriasis.
[1] https://www.ncbi.nlm.nih.gov/books/NBK333419/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684244/