Prodromes of Menstrual Staphylococcal Toxic Shock

Inclusion criteria

+Case inclusion criteria:

• Women between 13 and 30 years old inclusive
• Clinical diagnosis of staphylococcal toxic shock syndrome: "confirmed" or "probable" according to Center Disease Control (CDC) criteria:

The 5 CDC clinical criteria for menstrual Staphylococcal Toxic Shock are:

• a fever above 39°C,
• arterial hypotension,
• generalized scarlatiniform erythroderma
• intense peeling of the palms or soles of the feet 7 to 14 days later,
• and systemic manifestations (at least three):

• Digestive: vomiting, diarrhea
• Muscular: myalgia, increase in serum creatine phosphokinase
• Hyperemia of the vaginal, oropharyngeal and conjunctival mucous membranes
• Renal: hyperuricemia, hypercreatininemia, leukocyturia without urinary infection,
• Hepatic: increase in transaminases
• Hematological: thrombocytopenia (< 100,000 platelets/mm3)
• Neurological: apart from episodes of fever or hypotension such as disorientation or altered consciousness.

In the presence of 4 criteria, the case is considered probable and 5 criteria as confirmed case.

• Detection of S. aureus strain carrying Toxic shock syndrome toxin-1 (TSST1) on vaginal samples.
• Onset of symptoms ≤ 72 hours before the start of menstruation and ≥ 72 hours after the end of menstruation.
• Use during the last 3 cycles of vaginal protection: tampon or menstrual cup.

+Control inclusion criteria:

• Women between 13 and 30 years old inclusive
• Presence of menstruation
• Use of intimate periodic protection, tampon or menstrual cup, during the last 3 periods
• No history of toxic menstrual shock

Exclusion criteria

• Non-menstruating women
• Women protected by law
• Women (or relatives) who oppose the study