Nonmenstrual toxic shock syndrome associated with barrier contraceptives: report of a case-control study

Use of barrier contraceptives has been hypothesized to be a risk factor for nonmenstrual toxic shock syndrome (TSS). This association was evaluated in a case-control study of nonmenstrual TSS; cases were identified through an active surveillance system for TSS during 1986 and 1987. Potential risk factors for nonmenstrual TSS were compared for 28 patients and 100 age-matched controls. Use of barrier contraceptives was associated with a significantly increased risk of nonmenstrual TSS, with matched odds ratios of 10.5 and 11.7 for contraceptive sponge and diaphragm use, respectively. Use of nonbarrier contraceptive methods was unrelated to nonmenstrual TSS. Despite the elevated odds ratio, the incidence of nonmenstrual TSS in barrier contraceptives users and the risk of nonmenstrual TSS attributable to barrier contraceptive use are low. Clinicians and women who use barrier contraceptives should be aware of this rare but potentially fatal complication; however, other considerations, such as efficacy and complications associated with other types of contraception, may be more important in the choice of a contraceptive method.