Staphylococci associated with toxic shock syndrome in the United Kingdom

Only 15 cases of menstrual toxic shock syndrome were reported in the United Kingdom by 31 October 1981. The women affected used tampons of various brands. Staphylococcus aureus was isolated from the vaginas of 12 women. Two distinct strains were isolated from three women. Most strains were phage group I or nontypable strains related to them and were resistant only to penicillin, cadmium, and arsenate. Enterotoxin F was produced by strains from 10 of 12 patients and by 20% to 30% of strains from other sources--including healthy people. Its production was particularly common among control phage group I vaginal isolates. The reason for the rarity of toxic shock syndrome in the United Kingdom as compared to the United States is still unknown. There does not seem to be a low prevalence of toxigenic strains, but factors such as immunity to toxin and a difference in tampon use may be important and need further study.