Complex ecological interactions of Staphylococcus aureus in tampons during menstruation

Abstract

Menstrual toxic shock syndrome (mTSS) is a severe disease that occurs in healthy women vaginally colonized by Staphylococcus aureus producing toxic shock toxin 1 and who use tampons. The aim of the present study was to determine the impact of the composition of vaginal microbial communities on tampon colonisation by S. aureus during menses. We analysed the microbiota in menstrual fluids extracted from tampons from 108 healthy women and 7 mTSS cases. Using culture, S. aureus was detected in menstrual fluids of 40% of healthy volunteers and 100% of mTSS patients. Between class analysis of culturomic and 16S rRNA gene metabarcoding data indicated that the composition of the tampons’ microbiota differs according to the presence or absence of S. aureus and identify discriminating genera. However, the bacterial communities of tampon fluid positive for S. aureus did not cluster together. No difference in tampon microbiome richness, diversity, and ecological distance was observed between tampon vaginal fluids with or without S. aureus, and between healthy donors carrying S. aureus and mTSS patients. Our results show that the vagina is a major niche of. S. aureus in tampon users and the composition of the tampon microbiota control its virulence though more complex interactions than simple inhibition by lactic acid-producing bacterial species.

The Staphylococcus aureus CC398 Lineage: An Evolution Driven by the Acquisition of Prophages and Other Mobile Genetic Elements

“…vaginal colonization than studies based on vaginal swabbing [38] , and identified CC398 S. aureus as a prevalent vaginal colonizer [39]. As described for CC398 strains identified as nasal colonizers, these isolates were also devoid of superantigens (enterotoxin and tst genes).…”

“…Intestinal colonization is perhaps more relevant for this bacterium originating from an animal environment, but studies analyzing intestinal colonization have not been done. Recently, a study published by Chiaruzzi and colleagues analyzed tampon colonization in healthy women, which might be more representative of vaginal colonization than studies based on vaginal swabbing [38], and identified CC398 S. aureus as a prevalent vaginal colonizer [39]. As described for CC398 strains identified as nasal colonizers, these isolates were also devoid of superantigens (enterotoxin and tst genes).…”

Identification of Nasal Gammaproteobacteria with Potent Activity against Staphylococcus aureus: Novel Insights into the “Noncarrier” State

“…Vaginal microbial profiling showed an inverse relationship between Klebsiella spp. prevalence and S. aureus culture positivity ( 46 ). Correspondingly, Liu et al defined seven major nasal community state types (CSTs) and discovered that nasal microbiomes classified as CST2 ( Enterobacteriaceae [e.g., Klebsiella and Citrobacter ] prevalent) and CST6 ( Moraxella spp.…”

Determinants of Vaginal Microbiota Composition

“…Although S. aureus colonization is associated with tampon use (Jacquemond et al, 2018 ), it has been difficult to tease out menses-related from menstrual hygiene-related alterations to the overall vaginal microbiota. A study that compared the menstrual fluid microbiome from tampons cultured S. aureus from the menstrual blood of 40% of healthy women but found no clear difference in the other microbiota between those who had S. aureus colonization and those who did not.…”