The adherence of group A streptococci to epithelial cells was studied by using streptococcal strains labeled with [(3)H]uridine or fluorescein isothiocyanate. The ability of the labeled organisms to adhere to Detroit 562 epithelial cells, derived from a human pharyngeal carcinoma, as well as to epithelial cells scraped from the oral cavity was determined. Adherence to monolayer cultures or cell suspensions of Detroit cells compared favorably with adherence to suspensions of human oral epithelial cells. Initial experiments to determine the optimal conditions for adherence showed that adherence was temperature dependent and that the optimal incubation time was 15 min for adherence to epithelial cells in suspension and 30 to 60 min for monolayer cultures. Both streptococci and epithelial cells exhibited specificity in the adherence process. Different streptococcal strains varied in their ability to adhere. Adherence was also affected by the growth stage of the bacterial cultures. Trypsin treatment of the streptococci slightly decreased adherence, whereas hyaluronidase treatment increased the adherence of some strains. Streptococci were found to adhere to only about half of the epithelial cells. Those epithelial cells apparently have a limited number of receptor sites since they can be saturated by adding increasing concentrations of bacteria. Further support for limited receptor sites was provided by competition experiments. Adherence was inhibited by trypsin treatment of the epithelial cells, suggesting that proteins in the epithelial cell membrane may play a role in streptococcal adherence.