Recovery of Staphylococcus aureus from multiple body sites in menstruating women

Because we suspected the number of women harboring Staphylococcus aureus perivaginally to be higher than previously reported, we undertook an examination of normal, healthy volunteers. Of 97 young women, 26% yielded S. aureus from the external labia at the time of menstruation. Toxin associated with toxic shock syndrome was recovered from 5 of 25 subjects with positive genital cultures. Approximately one-half of the women with positive genital cultures yielded positive cultures from the posterior cervical fornix. These 12 women with positive vaginal cultures formed a distinct subgroup that was characterized by positive labial and tampon cultures, higher incidence of previous streptococcal infections, and more frequent vaginal insertion of their own fingers or those of a partner. Tampons were used by all but one woman in the group with positive labial cultures and all but one woman in the group with positive vaginal cultures. We concluded that the presence of S. aureus in the vagina involves mechanisms other than the use of tampons. Insertion of fingers and perhaps some aspect of immunological status appear to play a role.