Group A Streptococcus (Strep A) is an important cause of mortality and morbidity globally. This bacterium is responsible for a range of infections and post-infectious sequelae which includes rheumatic heart disease. Droplet transmission is the dominant paradigm, but little is known about the relative contribution of other modes of transmission of Strep A infection. We aimed to summarise contemporary evidence of Strep A transmission in humans to inform the development of evidence-based environmental health prevention and control strategies to reduce transmission and the burden of Strep A diseases.