Vaginal Tampon Colonization by Staphylococcus aureus in Healthy Women

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