Nature of TSST-1 Production by Staphylococcus aureus in Aberrant Vaginal Conditions

Menstrual-toxic shock syndrome (TSS) is a serious illness that afflicts women of pre-menopausal age worldwide, and arises from vaginal infection by Staphylococcus aureus and concurrent production of toxic shock syndrome toxin- 1 (TSST-1). The aim of this study was to investigate the influence of aberrant vaginal states and indigenous vaginal bacteria on production of TSST-1 and identify women who are most susceptible to menstrual-TSS. A TSST-1 reporter strain of S. aureus was grown in the presence of vaginal swab contents collected from women in London, Ontario with healthy and aberrant vaginal states. Gene expression assays were also conducted to monitor toxin production in response to indigenous vaginal bacteria. This study found that Streptococcus agalactiae significantly induces TSST-1 production, while resident Lactobacillus spp. suppress production. Results also indicate that women with aerobic vaginitis, but not bacterial vaginosis, may be more susceptible to menstrual-TSS and would benefit most from prophylactic treatment