Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 10:21:100308.
doi: 10.1016/j.eclinm.2020.100308. eCollection 2020 Apr.

Association of characteristics of tampon use with menstrual toxic shock syndrome in France

Amaury Billon  1 , Marie-Paule Gustin  2 , Anne Tristan  1   3 , Thomas Bénet  4 , Julien Berthiller  5 , Claude Alexandre Gustave  1   3 , Philippe Vanhems  2   4   5 , Gerard Lina  1   3
Affiliations

Association of characteristics of tampon use with menstrual toxic shock syndrome in France

Amaury Billon et al. EClinicalMedicine. .

Abstract

Background: Menstrual tampons are widely used in western countries. Indirect evidence suggests that tampon misuse could be associated with an increased risk of menstrual toxic shock syndrome (MTSS). The aim of this study was to determine what characteristics of tampon use are associated with increased risk of menstrual toxic shock syndrome (MTSS).

Methods: A nationwide, case-control study in France, was conducted with women that use tampons with MTSS diagnoses according to the CDC diagnostic criteria (n = 55, from January 2011, to December 2017) and a control group of women with no MTSS history (n = 126, from February to December 2017). Information regarding tampon use during a 6-month period was collected. Associations between tampon use and MTSS were assessed using logistic regression models stratified by residential area.

Findings: Compared to controls, women diagnosed with MTSS more frequently reported maximum tampon wear of >6 h (62% vs. 41%; P = 0.02), overnight tampon use (77% vs. 54%; P = 0.006), and neither read nor followed tampon instructions in case of reading (65% vs. 42%; P = 0.006). In univariate analysis, MTSS risk was two-fold higher with tampon use for >6 consecutive hours (odds ratio, 2.3 [95% CI, 1.2-4.5]), and three-fold higher with tampon use during sleep for >8 h (odds ratio, 3.2 [95% CI, 1.4-7.7]). In multivariate logistic regression analysis, only maximum tampon use for >6 h (odds ratio, 2.03 [95% CI, 1.04-3.98]), and neither read nor followed the tampon instructions in case of reading (odds ratio, 2.25 [95% CI, 1.15-4.39]) were independently associated with MTSS.

Interpretation: Our study suggests that the risk of MTSS was associated with using tampons for more than 6 h, overnight tampon use during sleep, and neither read nor followed tampon insertion instructions in case of reading.

Funding: LABEX ECOFECT (ANR-11-LABX-0048) of Université de Lyon within the programme "Investissements d'Avenir" (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR).

Keywords: Case-control study; Menstrual toxic shock syndrome; Staphylococcus aureus; Tampon use; Tampons.

PubMed Disclaimer

Conflict of interest statement

Thomas Benet was employed by bioMérieux from January 2018 to October 2019, working in a topic outside of the submitted work. Claude-Alexandre Gustave reports grants from LABEX ECOFECT (ANR-11-LABX-0048) of Université de Lyon within the programme “Investissements d'Avenir” (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR) during the conduct of the study. Philippe Vanhems reports grants and personal fees outsides the submitted work from Astellas, Biosciences, MSD and Pfizer.

References

    1. Todd J., Fishaut M., Kapral F., Welch T. Toxic-shock syndrome associated with phage-group-I Staphylococci. Lancet. 1978;2:1116–1118. - PubMed
    1. Spaulding A.R., Salgado-Pabón W., Kohler P.L., Horswill A.R., Leung D.Y.M., Schlievert P.M. Staphylococcal and streptococcal superantigen exotoxins. Clin Microbiol Rev. 2013;26:422–447. - PMC - PubMed
    1. Hajjeh R.A., Reingold A., Weil A., Shutt K., Schuchat A., Perkins B.A. Toxic shock syndrome in the United States: surveillance update, 1979 1996. Emerg Infect Dis. 1999;5:807–810. - PMC - PubMed
    1. Berger S., Kunerl A., Wasmuth S., Tierno P., Wagner K., Brügger J. Menstrual toxic shock syndrome: case report and systematic review of the literature. Lancet Infect Dis. 2019;19:e313–e321. - PubMed
    1. Reingold A.L. Nonmenstrual toxic shock syndrome: the growing picture. JAMA. 1983;249:932. - PubMed

LinkOut - more resources