Association of Characteristics of Tampon Use with Menstrual Toxic Shock Syndrome in France

Background: Menstrual tampons are widely used in western countries. Indirect evidence suggests that tampon misuse could be associated with an increased risk of menstrual toxic shock syndrome (MTSS). The aim of the study was to determine tampon use associated with increased risk of menstrual toxic shock syndrome (MTSS). Methods: A nationwide, case-control study in France, was conducted with women that use tampon with MTSS diagnoses according to the CDC diagnostic criteria (n=55, from January 2011, to December 2017) and controls women with no MTSS history (n=126, from February to December 2017). Information regarding tampon use during a 6-month period was collected. Associations between tampon use and MTSS were assessed using logistic regression models stratified by residential area. Findings: Compared to controls, cases more frequently reported maximum tampon wear of >6 hours (62% vs. 41%; P=0.02), overnight tampon use (77% vs. 54%; P=0.006), and not having read and followed tampon instructions (65% vs. 42%; P=0.006). In univariate analysis, MTSS risk was two-fold higher with tampon use for >6 consecutive hours (odds ratio, 2.3 [95% CI, 1.2–4.5]), and three-fold higher with tampon use during sleep for >8 hours (odds ratio, 3.2 [95% CI, 1.4–7.7]). In multivariate logistic regression analysis, only maximum tampon use for >6 hours (odds ratio, 2.03 [95% CI, 1.04–3.98]), and not reading and following the tampon instructions (odds ratio, 2.25 [95% CI, 1.15–4.39]) were independent associated with MTSS. Interpretation: Our study indicates suggests that risk of MTSS was associated with women who used tampons for more than 6 hours, overnight tampon during sleep, and who reported not reading and following tampon insertion instructions. Funding Statement: This work was supported by the LABEX ECOFECT (ANR-11-LABX-0048) of Universite de Lyon within the programme "Investissements d'Avenir" (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR). Declaration of Interests: The authors declare no competing interest. Ethics Approval Statement: This study was reviewed and accepted by the Ethics Committee (CPP Sud Est IV, Centre Leon Berard, Lyon, France, N° L16-176). Written consent was obtained from all participants, or from the parents/guardians of participants under 18 years of age.