title: Invasive group a streptococcus associated with an intrauterine device and oral sex.
abstract: BACKGROUND
  Peritonitis due to group A Streptococcus (GAS) and toxic shock syndrome occurred in a previously healthy 45-year-old woman with an intrauterine device. The intrauterine device was believed to be the portal of entry. In addition, her husband was found to be an asymptomatic carrier of GAS in his oropharynx.
  
  
  OBJECTIVE
  The goal was to increase physicians' awareness of oral sex as a risk factor for transmission of invasive GAS disease.
  
  
  METHODS
  This is a case report of the development of GAS peritonitis and toxic shock syndrome in a woman after acquisition of the organism through oral sex.
  
  
  RESULTS
  The GAS strains isolated from the patient and her husband were identical in their M-type, T-type, and exotoxin gene pattern.
  
  
  CONCLUSIONS
  Because the couple practices oral sex, it was postulated that this was the mode of transmission of the GAS.
authors.affiliation: Technion Israel Institute of Technology Faculty of Medicine, Haifa, Israel.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Gisser
authors.forename: Madeline C
authors.initials: MC
authors.lastname: Fields
authors.forename: Neorah
authors.initials: N
authors.lastname: Pick
authors.forename: Allon E
authors.initials: AE
authors.lastname: Moses
authors.forename: Isaac
authors.initials: I
authors.lastname: Srugo
mesh_terms: D002353:Carrier State / Q000382:microbiology; D018562:Disease Transmission, Infectious; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000382:microbiology*; D012725:Sexual Behavior; D015231:Sexually Transmitted Diseases, Bacterial / Q000635:transmission*; D012772:Shock, Septic / Q000382:microbiology*; D013290:Streptococcal Infections / Q000635:transmission*; D013297:Streptococcus pyogenes / Q000235:genetics / Q000302:isolation & purification*