Vaginal tampon model for toxic shock syndrome

Rev Infect Dis. Jan-Feb 1989;11 Suppl 1:S238-46; discussion S246-7. doi: 10.1093/clinids/11.supplement_1.s238.


The effects of tampon composition, inoculum size, and simulated menses on production of toxic shock syndrome toxin 1 (TSST-1) and toxic shock syndrome (TSS) were evaluated in a rabbit model that simulates tampon use in humans. Three small generic compressed-fiber tampons were successively inserted vaginally (remained in place 4.5 hours x 2; overnight x 1). Tampon no. 1 was inoculated with live TSST-1-positive staphylococci plus 5 mL of saline or simulated menses (defibrinated rabbit blood plus 2.5 g of bovine serum albumin/dL) immediately after insertion; saline or simulated menses alone were used with tampons no. 2 and 3. The vagina was washed after removal of tampon no. 3. TSS-like illness was produced consistently in animals with carboxymethyl cellulose/polyester foam tampons, which supported higher organism counts and greater TSST-1 production in association with subsequent tampons. Cotton and rayon tampons were not associated with as much clinical illness, organism growth, or TSST-1 production. Simulated menses supported toxin production and clinical illness when the inoculum was one-tenth that required for controls. Sham tampon insertion was associated with TSS-like illness in two of 10 rabbits; thus, other factors may promote TSS in the absence of vaginal tampons. This model reliability reproduces menstrual TSS, since one-time vaginal inoculation with TSST-1-positive staphylococci in the presence of blood and certain tampons leads to TSS, and may be useful in evaluating catamenial products and in understanding other factors important in TSST-1 production in vivo and the development of TSS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bacterial Toxins*
  • Cellulose
  • Disease Models, Animal
  • Enterotoxins / biosynthesis
  • Female
  • Gossypium
  • Menstrual Hygiene Products / adverse effects*
  • Menstruation
  • Polyesters
  • Rabbits
  • Shock, Septic / etiology*
  • Shock, Septic / microbiology
  • Staphylococcus aureus / growth & development
  • Staphylococcus aureus / metabolism
  • Superantigens*


  • Bacterial Toxins
  • Enterotoxins
  • Polyesters
  • Superantigens
  • enterotoxin F, Staphylococcal
  • Cellulose
  • rayon, purified