Vaginal Tampon Colonization by Staphylococcus aureus in Healthy Women

Abstract

Tampons recovered from a cohort of 737 healthy women (median age 32 years) were analyzed for the presence of Staphylococcus aureus. A total of 198 tampons (27%) were colonized by S. aureus, and 28 (4%) was by a strain producing toxic shock syndrome toxin 1 (TSST-1). S. aureus was detected more frequently in tampons that did not require an applicator for their insertion (74/233 [32%] versus 90/381 [24%]; OR=1.51 [95% CI 1.04-2.17]) and in women who used an intrauterine device for contraception (53/155 [34%] versus 145/572 [27%]; OR =1.53 [95% CI 1.05-2.24]). The S. aureus strains isolated from tampons belonged to 22 different clonal complexes (CCs). The most prevalent CC was CC398 agr1 (n=57, 27%), a clone that does not produce superantigenic toxins, followed by CC30 agr 3 (n=27, 13%) producing TSST-1 (24/27 [89%]), the principal clone of S. aureus involved in menstrual toxic shock syndrome. IMPORTANCE Menstrual toxic shock syndrome (MTSS) is an uncommon severe acute disease that occurs in healthy menstruating women colonized by TSST-1-producing S. aureus who use intravaginal protection, such as tampons and menstrual cups. The catamenial product collected by the protection serves as a growth medium for S. aureus and allows TSST-1 production. Previous studies evaluated the prevalence of genital colonization by S. aureus by vaginal swabbing, but they did not examine tampon colonization. This study demonstrates a high prevalence of tampon colonization by S. aureus, and the presence of the CC30 TSST-1 S. aureus clone responsible for MTSS in tampons from healthy women. The results support the vaginal carriage of this lineage in healthy women. In addition, the higher prevalence of S. aureus within tampons that do not require an applicator indicates a crucial role of hand-washing before tampon handling to decrease the risk of tampon contamination.

The Staphylococcus aureus CC398 Lineage: An Evolution Driven by the Acquisition of Prophages and Other Mobile Genetic Elements

“…vaginal colonization than studies based on vaginal swabbing [38] , and identified CC398 S. aureus as a prevalent vaginal colonizer [39]. As described for CC398 strains identified as nasal colonizers, these isolates were also devoid of superantigens (enterotoxin and tst genes).…”

“…Intestinal colonization is perhaps more relevant for this bacterium originating from an animal environment, but studies analyzing intestinal colonization have not been done. Recently, a study published by Chiaruzzi and colleagues analyzed tampon colonization in healthy women, which might be more representative of vaginal colonization than studies based on vaginal swabbing [38], and identified CC398 S. aureus as a prevalent vaginal colonizer [39]. As described for CC398 strains identified as nasal colonizers, these isolates were also devoid of superantigens (enterotoxin and tst genes).…”

Effects of Hemp Sanitary Pads on the Vaginal Microecology

“…The safety of hygiene products has always been a concern. There are many studies on the relationship between sanitary products and reproductive tract infections, most of which focus on tampons and menstrual cups [ 7 , 8 ]. There are few studies on the effect of sanitary pads on reproductive tract infection.…”

Potential Use of Lactobacillus gasseri G10 Isolated from Human Vagina along with Intrauterine Devices (IUD) to Prevent Pathogen Colonization

“…Studies showed that Lactobacillus spp. have an antimicrobial impact on growth of S. aureus, which may cause toxic shock syndrome by colonizing and producing biofilm on intravaginal products, and C. albicans in addition to preventing their attachment to vaginal epithelium [21,38,50]. Ten different lactobacilli strains have been evaluated for development of vaginal tablets used to treat vaginal infections as replacement for antibiotics [51].…”