Impact of Tampons and Menstrual Cups
on Staphylococcus aureus Growth and Toxic Shock Syndrome

 

A study from France, published 31.5.2018[1], studied impact of Currently Marketed Tampons and Menstrual Cups on Staphylococcus aureus Growth and Toxic Shock Syndrome.

 

TAMPONS

Fifteen currently marketed intravaginal protection products (11 types of tampon and 4 types of menstrual cup) were tested to determine their effect on Staphylococcus aureus growth and toxic shock syndrome toxin 1 (TSST-1) production.

 

Most tampons reduced S. aureus growth and TSST-1 production, with differences based on brand and composition, and the level of S. aureus growth was higher in destructured than in unaltered tampons.

 

S. aureus growth was not statistically correlated with tampon absorbance, but S. aureus behaviors varied significantly as a function of the tampon composition. The level of S. aureus growth was lower with tampons composed of a mix of rayon and cotton than with those composed of viscose with or without the addition of cotton or cotton alone.

 

Levels of S. aureus growth were equivalent for tampons made of viscose or a mix of viscose and cotton and lower than those for tampons made of cotton alone.

 

The space between the fibers in the tampon may contribute to the intake of air in the vagina and could represent the major site of S. aureus growth and toxin production.

 

Long tampon carriage may also alter the structure in a manner favoring S. aureus growth and TSST-1 production, advocating for a short time of use and frequent changing.

 

MENSTRUAL CUPS

They observed higher levels of S. aureus growth and toxin production in menstrual cups than in tampons, potentially due to the additional air introduced into the bag by cups, with differences based on cup composition and size.

 

The level of S. aureus growth was significantly lower with cups made from thermoplastic elastomers (TPE) than with those made from silicone.

 

A significant amount of biofilm of S. aureus remained after 8 h and 3 washes with water, regardless of the cup model or composition. Manual instructions for the menstrual cup indicate that the cup could be removed, emptied, and rinsed with tap water before being reinserted, but results suggest that women may reinsert a contaminated cup when following this advice. A protocol including a second cup that allows for cup sterilization by boiling between uses should be recommended.

 

They observed slight increases of S. aureus growth and toxin production with menstrual cups, due to the introduction of a higher volume of air than that occurring with tampons in  in vitro system. The use of a small cup should be advised to limit this effect.

 

Both intravaginal devices – tampons and menstrual cups appear to be risk factors for the development of menstrual toxic shock syndrome, and precautions should be advised.

 

 

[1] Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981080/