[Clinical and bacteriological effects of xanthocillin containing gelatine tampons AWD compared to other resorbable tampon material].
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Anti-Bacterial Agents↗
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[Tampon disease without tampons; toxic shock syndrome in childhood].
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Age Factors↗
Production of toxic shock syndrome toxin 1 by Staphylococcus aureus as determined by tampon disk-membrane-agar method.
The influence of 17 commercially available tampons on production of toxic shock syndrome toxin 1 (TSST-1) by Staphylococcus aureus was investigated by using a tampon disk method. Filter membranes overlaying agar medium (with or without blood) in small petri dishes were spread inoculated with a TSST-1-producing strain of S. aureus. Disks cut from unrolled tampons were pressed and laid on the inoculated membranes; incubation was for 19 h at 37 degrees C with 5% CO2 in air. CFU on the membranes and in the disks were enumerated, and the presence of TSST-1 in the disks and in the agar layers was determined. Tampons made of different materials supported characteristic levels of cell growth and toxin production in the tampon. Colonization of the interface surface of the tampon disks was heavy. The number of CFU extracted from the tampon disks ranged from 5 X 10(10) to 82 X 10(10). There was little variation in the CFU recovered from the membranes ([1.9 +/- 0.4] X 10(11)). Sixty to 170 micrograms of TSST-1 was recoverable from the agar, with an additional 10 to 90 micrograms recoverable from tampon disks, depending on the type of tampon disk. The amount of toxin in the agar layer from the various tampon disks was relatively constant and indicated an important contribution of toxin from vaginal S. aureus cells not growing in the tampon. The main role of tampons in toxic shock syndrome may be that of providing a fibrous surface for heavy colonization and sufficient air for TSST-1 production.
Bacterial Toxins↗
Hymenal findings in adolescent women: impact of tampon use and consensual sexual activity.
We undertook a prospective study of 300 postmenarcheal female subjects (median age, 18.0 years) to examine (1) the relation of tampon use, sports participation, prior gynecologic examination, and consensual sexual activity to hymenal anatomy, (2) the factors leading to choice of tampons by girls not sexually active, and (3) factors related to ease of gynecologic examination. The sample included 100 subjects in group 1, who denied sexual intercourse and used only pads for menses; 100 subjects in group 2, who denied sexual intercourse and had used tampons; and 100 subjects in group 3, who gave a history of sexual intercourse. Sexually active subjects (81%) were significantly more likely than tampon users and pad users to have "complete clefts" in the lower hymen between the 2 o'clock and 10 o'clock positions (p < 0.001); tampon users were not significantly different from pad users (11% vs 5%). In subjects who were not sexually active, the presence of these complete clefts was not related to participation in sports or to prior pelvic examination. Although median hymenal opening diameter differed in the three groups (1.2 cm for group 1 vs 1.5 cm for group 2 vs 2.5 cm for group 3; p < 0.0001), the ranges of measurements were wide. Tampon users were significantly more likely than pad users to have mothers and friends, but not sisters, who had a favorable attitude toward tampon use. The best predictors of tampon use in a multivariate model were a favorable maternal attitude (odds ratio (OR), 5.3; 95% confidence interval (CI), 2.4, 12.1) and friends' use of tampons (OR 7.9; 95% CI 3.5, 18.1). Only 26% of speculum examinations in pad users were rated as easy compared with 56% of examinations in tampon users and 81% in sexually active young women (p < 0.001). The best predictors of ease of speculum examination were sexual activity (OR 15.9; 95% CI 1.9, 135.3) and tampon use (OR 3.6; 95% CI 1.0, 12.7). This large sample should provide useful data for physicians who testify in sexual assault cases and gives new information on the predictors of tampon use and ease of gynecologic examination in young women.
Adolescent↗
Vaginal tampon model for toxic shock syndrome.
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.
Animals↗
Quantitative assessment of vaginal microflora during use of tampons of various compositions.
Although the effect of vaginal tampons on the microbial flora during menstruation has recently been studied by several investigators, quantitative effects attributable to particular tampon fibers have received less attention. The purposes of the present study were (i) to determine and then to compare the effects of polyacrylate rayon tampons and viscose rayon tampons on the normal vaginal flora, (ii) to compare quantitative bacterial counts obtained from these tampons with those obtained from concomitant vaginal swabs, and (iii) to determine whether either of these tampon types alters the vaginal microflora when compared with the microflora in the same women using all-cotton tampons or external catamenial pads. Tampon and swab samples were obtained at predetermined times from 18 women for an average of seven menstrual cycles. Samples consisting of swabs from women wearing menstrual pads were compared with swab and tampon samples taken at predetermined times during the menstrual cycle from women using cotton, polyacrylate rayon, or viscose rayon tampons. Samples were analyzed for total aerobic, facultative, and anaerobic bacterial counts. Statistical evaluation of the results indicated that, on the whole, total bacterial counts decreased during menstruation and that the numbers of bacteria in tampons tended to be lower than those in swab samples taken at the same time. The tampon type had little effect on the vaginal microflora.
Adult↗
[Synchronization of estrus in heifers using Chlorsuperlutin (CSL) vaginal tampons].
A pilot experiment with heifer heat synchronization with chlorsuperlutin-soked intravaginal tampons was conducted with 254 heifers in six herds in the North Moravian region. The rubber-foam tampons, cylindrical in shape (diameter 70 mm, height 70-90 mm), were introduced into the cranial part of the vagina, using an applicator and a vaginal speculum. Sixteen days after introduction, the tampons were removed by pulling the silon thread with which the tampons were cross-stitched. The heifers were inseminated on the second to fifth day after the removal of the tampons. The average performance in the application of the tampons was 38.5 tampons per hour, and in their removal 20.7 tampons per hour. The retention rate of the tampons was 97.6%; out of this, 79.8% of the tampons were pulled out by the silon thread. The signs of heat were good, 87.9% of the heifers could be inseminated intrauterinally. All the heifers with retained tampons were inseminated. The conception rate after the first insemination was 32.7%, after the second insemination 56.4%, and after two inseminations 68.1%. Out of the synchronized heifers, 8.1% were culled for slaughter. The drawbacks of this treatment include the low conception rate of the synchronized heifers, a high requirement for repeated insemination in the synchronized oestrus, and, consequently, a high sperm consumption.
Animals↗
Tampon samplings with longer cervicovaginal cell exposures are equivalent to two consecutive swabs for the detection of high-risk human papillomavirus.
BACKGROUND: Self-sampling for human papillomavirus (HPV) is useful for triage of ASCUS Papanicolaou (Pap) smears. Tampons with 10-second cervicovaginal cell exposure can detect HPV but appear to be less efficient than two consecutive swabs. GOAL: The purpose of this study was to evaluate increased vaginal tampon exposures for detecting high-risk HPV. STUDY DESIGN: This longitudinal cohort study followed women who self-sampled weekly with tampons for progressively longer periods of time. A tampon was inserted for 10 seconds at the office visit and 1 hour, 4 hours, and overnight for the three subsequent home samples. Two concurrent swabs were used with each tampon sampling for contemporaneous comparisons. The MY09/MY11 PCR primer system with reverse line blot detection strips was used to detect 18 distinct high-risk HPV types. RESULTS: Of the 309 tampons and 618 swabs used at home, 83% were returned. Among normal women, the 10-second tampon detected fewer with normal histology and high-risk HPV than did its swabs ( = 0.0412), but the 1-hour, 4-hour, and overnight tampons had high-risk-HPV detection rates equal to their swabs. In women with CIN, all tampons and swabs equally identified those with high-risk HPV. CONCLUSION: Self-sampling for HPV detection is acceptable, feasible, and technically accurate for both tampons with longer cervicovaginal exposures and swabs. The choice of technique is dependent on the woman, her culture, and her clinician.
Diagnosis, Differential↗
Production of toxic shock syndrome toxin 1 by Staphylococcus aureus restricted to endogenous air in tampons.
All types of four brands of tampons were tested in triplicate by a tampon sac method for their effect on production of toxic shock syndrome toxin 1 (TSST-1). In this method the available air is limited to that which is in the tampon sac. Tampons were weighed and inserted into dialysis sacs inoculated with a TSST-1-producing Staphylococcus aureus strain; the sacs were submerged into brain heart infusion agar, which was allowed to harden around the sacs, and were incubated for 18 h at 37 degrees C. The tampons were removed, weighed, and extracted; the CFU of staphylococci and the amount of toxin present in the extracts were determined. Glass wool was used in place of the tampons as one control, and inoculated empty sacs were used as a second control. The total CFU were consistently greater than 2 X 10(11) for the tampons and glass wool and less than or equal to 10(11) for the empty sac control. Total toxin production for all tampons tested and the glass wool was 2 to 10 times higher than the toxin produced with the empty sac control. These results indicate that tampons provide increased surface area for the staphylococci to grow and adequate oxygen for toxin production. No significant inhibition of growth of the staphylococci or TSST-1 production by any of the tampons tested was noted.
Aerobiosis↗
The relationship of tampon characteristics to menstrual toxic shock syndrome.
The pathogenic basis for the association of tampons with toxic shock syndrome (TSS) has not been explained adequately. Absorbency and chemical composition of tampons are related, and no prior study has had a sufficient number of cases to evaluate these independently as risk factors for disease. We compared national TSS passive surveillance data on the 285 tampon-associated menstrual cases of TSS reported from 1983 to 1984 with data on age- and year-matched controls from national surveys of tampon usage. Users of all brands of tampons had elevated risks when compared with non-tampon users (odds ratio, 32.8; 95% confidence interval, 15.5, 69.6). Regardless of the chemical composition of the tampon, increasing absorbency increased the odds ratio for TSS. Chemical composition also influenced odds ratios. Polyacrylate-containing tampons had odds ratios that were elevated but, once controlled for absorbency, that were lower than the odds ratios for cotton, rayon, and cotton/rayon tampons. The strong association of absorbency with risk of illness would suggest that as a public health measure the use of a low-absorbency tampon is likely to reduce the risk of TSS in the user.
Adolescent↗
Tampon use in young women.
OBJECTIVE: To study the prevalence of tampon use among young females, the factors and persons influencing this choice, the role of primary care physicians, and the potential association of tampon use with sexually transmitted diseases and urinary tract infections. METHODS: An anonymous questionnaire regarding the use of feminine hygiene products was completed by 250 female college students between 17 and 21 years of age and 90 primary care physicians. Percentages were calculated for most outcome measurements and Fisher's Probability Exact Test was used to compare groups. RESULTS: Of the participants, 19% use pads, 29% use tampons, and 52% use both, with a total of 81% using tampons alone or in combination. The choice was influenced mostly by the woman herself or her mother. Only 22% reported that their physician discussed tampon usage with them. Incidence of sexually transmitted diseases was not significantly different between those using pads and tampons. In the pad group, 12% reported urinary tract infections versus 32% in the other group (P = 0.007). Among physicians, only 30% said they discussed hygiene products, although 52% of them thought it was medically important. Of the female physicians, 71% use tampons alone or in combination; 29% exclusively use pads, with 92% citing fear of toxic shock syndrome as a reason for their choice. CONCLUSIONS: The majority of young women use tampons based on own decision or maternal influence for comfort, convenience, and appearance. Physician input in this regard is not routinely provided, probably because of lack of agreement about the importance of the subject among physicians. Based on participants' report in this survey, the incidence of urinary tract infections seems to be significantly higher among tampon users than among pad users. Physicians should assume a more active role in explaining the appropriate use, benefits, and potential risks of feminine hygiene products.
Adolescent↗
[The use of vaginal tampons in hospital and practice].
Industrially manufactured cotton wool tampons have been used for 5 years on approx. 5,000 women. The tampons were used in cases of inflammatory diseases of the vagina and of the cervix as well as postoperatively after abdominal and vaginal operations in order to apply medicaments. The absorbing effect of the tampons immediately stops the disagreeable secretion. The insertion of the tampons is simple and can be performed by the women themselves. Use of the pre-fabricated tampons is more economical than that of those tampons developed by our personnel. The advantages of the tampons during menstruation as well as during sports activities while menstruating are discussed. No side effects were observed during tampon use provided the tampons were inserted correctly.
Female↗
A diaphragm tampon applied to an ovulation method in a birth control system.
Gynaeseal is a re-usable diaphragm tampon made from latex which forms a unique cervico-vaginal seal and isolates menstrual loss. In a prospective study involving 80 women, Gynaeseal was offered in combination with the Billings Ovulation Method in an advised birth control system. This system included: use of the diaphragm tampon during the menstruation-fertile phase interphase; periodic abstinence during the overtly fertile phase of the cycle; and if extreme reliability was required, for a further 2 days after the Billings method 'rules' allow resumption of intercourse. The diaphragm tampon successfully complemented the Billings Ovulation Method with 44 women (60.4%) assessing the GOM System as being as good, or better than, currently available reversible methods. It functioned effectively as a tampon with 50% (31 women) stating that they used the product as a contraceptive. One woman claimed an unplanned pregnancy. No significant medical complications were recorded. The product has major advantages as a tampon: it is easily and accurately inserted because of the efficient applicator; it isolated menstrual loss within a collection chamber; it protects the cervix; and it facilitates sexual activity. Based on a minimum effective diameter (62mm), the diaphragm tampon does not interfere with the normal physiology of the vagina. There appeared to be no significant distortion of normal adult pelvic anatomy, and properly placed, no sensation of the diaphragm tampon's presence. Regarding insertion of the diaphragm tampon using the spiral-curved applicator: 31 women (42.5%) had little or no difficulty; 29 (39.7%) moderate difficulty; 13 (17.8%) experienced serious difficulty; and 7 (8.7%) were unable to use the product.
Adolescent↗
Role of air in growth and production of toxic shock syndrome toxin 1 by Staphylococcus aureus in experimental cotton and rayon tampons.
Rayon and cotton fibers of the type used in the manufacture of tampons were extracted for 6 hours in isopropyl alcohol in a soxhlet apparatus to remove all finishes from the fiber surface. The fibers were used to produce experimental tampons of commercial design. Using a syringe method, the tampons were saturated with diluted staphylococci in brain-heart infusion medium and incubated at 37 degrees C. Spent medium was expressed from the tampons and analyzed for growth of staphylococci and production of toxic shock syndrome toxin 1 (TSST-1). Results revealed no statistical difference in the production of TSST-1 by cells grown in rayon or cotton. However, a significant increase in TSST-1 production was observed in tampon cultures when compared with medium controls. When similar experiments were performed with tampons saturated with nitrogen, a significant decrease in TSST-1 production was observed when compared with air-saturated tampons. The results indicate that the oxygen normally present in tampons plays a significant role in modulating the production of TSST-1.
Aerobiosis↗
Comparison of cotton and cotton/rayon tampons for effect on production of toxic shock syndrome toxin.
Studies were done to compare tampons made solely of cotton and made of both cotton and rayon for effect on growth of Staphylococcus aureus and production of toxic shock syndrome toxin-1 (TSST-1). Under stationary in vitro conditions in which tampons were either oversaturated or 50% saturated with culture media, the same amount of or more TSST-1 was made with cotton tampons than with cotton/rayon tampons. Similarly, when tested with the tampon sac method, cotton tampons yielded the same amount of or more toxin than did the cotton/rayon tampons. Bacterial cell numbers generally paralleled toxin production. These data indicate that cotton tampons neither prevent TSST-1 production nor significantly adsorb toxin onto the fibers to make toxin unavailable to cause toxic shock syndrome, in contrast to results of a previous study.
Bacterial Toxins↗
Evaluation of patient-administered tampon specimens for Chlamydia trachomatis and Neisseria gonorrhoeae.
BACKGROUND: The patient-administered tampon specimen has proven to be an easy and sensitive method for the diagnosis of genital Chlamydia trachomatis and Neisseria gonorrhoeae infections in women by polymerase chain reaction (PCR). This method avoids the need for endocervical sampling and stringent criteria for transport. GOAL: To evaluate two commercial amplification systems for the detection of C trachomatis and N gonorrhoeae from tampon specimens. STUDY DESIGN: A group of 400 positive and negative tampon specimens tested by an in-house PCR method were selected from a pool of more than 2,000 previously collected tampons. Overall, 93 C trachomatis-positive and 77 N gonorrhoeae-positive specimens were evaluated. Each specimen was tested by Roche Cobas Amplicor and Abbott LCx (LCR), and results were compared to the in-house PCR method. RESULTS: Detection of C trachomatis by both assays was not significantly different from the in-house PCR assay. Fewer tampons were positive for N gonorrhoeae by LCR than either the in-house assay (P = 0.0001) or by Roche Amplicor (P = 0.01). However, tampon specimens tested by Roche Amplicor required DNA extraction to achieve comparative sensitivity. CONCLUSION: Both commercial assays can be applied to tampon-collected specimens for automated detection of sexually transmitted diseases. The detection of C trachomatis was similar to the in-house PCR test for both assays (P = 0.73, 0.68). Detection of N gonorrhoeae resulted in fewer positive tampon specimens when tested by ligase chain reaction than both Roche Amplicor and in-house PCR.
Chlamydia Infections↗
Predictors of tampon use in adolescents after media coverage of toxic shock syndrome.
Adolescents who use tampons represent the population most susceptible to toxic shock syndrome. We surveyed 714 adolescents from two high schools and three hospital-based clinics to examine patterns of tampon use before and after media coverage on toxic shock syndrome. Predictors of behavior change in adolescent users of tampons were examined in the context of a theoretical model of preventive health behavior. Subjects were 168 adolescents, ages 13 to 19 (mean age, 15.19; mean gynecologic age, 3.4); 50% of the subjects were white; 19%, Asian; 16% black; 7%, Hispanic; and 6%, other. After extensive publicity on toxic shock syndrome, 33.9% of the subjects changed their habits of tampon use; 27.5% stopped using tampons and 6% decreased their use of tampons. Linear logistic regression analyses identified two factors that distinguished adolescents who decreased or stopped use of tampons after publicity on toxic shock syndrome from those who did not: greater likelihood of Rely tampon (Procter & Gamble) use before publicity (p = 0.014) and the belief that they were especially susceptible to toxic shock syndrome (p = 0.013).
Adolescent↗
[Insertion and removal of intravaginal tampons during estrus synchronization in heifers].
In eight trials, 197 heifers were synchronized with gestagen chlorsuperlutin (CSL). The intravaginal tampons soaked with chlorsuperlutin were introduced in the vagina by means of an applier by a vaginal speculum. Silon threads were attached to the tampons, by which they were pulled out after treatment. The mentioned method of application removes the great physical exertion needed for manual application and increases labour productivity in tampon application by about 200%. The hazard of tampon contamination is reduced to the minimum. Of the two tampon types tested (ester and ether type) the ester type was found to be better for not needing sterilization if the disinfectant Aseptin is dropped upon it prior to application. The retention of the tampons was 94.9%. Eighty-four per cent of the retained tampons could be removed by pulling the silon threads. About 40 to 60% of CSL is excreted from the tampons during the treatment. If the initial content of CSL is increased, its excretion is raised as well.
Animals↗