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.