title: Site-specific prevalence and cell densities of selected microbes in the lower reproductive tract of menstruating tampon users.
abstract: OBJECTIVE
  To assess differences in prevalence and cell densities of enterococci, Gram negative enterics (GNEs), yeast and Staphylococcus aureus among four genital sites and to examine whether the presence of organisms at one site affected the presence of organisms at other sites.
  
  
  METHODS
  Swab samples from the perineum, below and above the hymen, and the posterior fornix obtained from 52 tampon users on menstrual cycle day 3 were analyzed for site-specific prevalence and cell densities of microorganisms.
  
  
  RESULTS
  Enterococci and GNEs were the most prevalent study organisms at all sites and decreased in prevalence from the perineum to the posterior fornix. Cell densities similarly decreased from below the hymen to the posterior fornix. Yeast were detected at the hymen only; S. aureus frequency was similarly low at all sites. Yeast and S. aureus site-specific cell densities were similar. The above- and below-hymen sites were similar in prevalence and cell density of organisms. An above-chance association existed between the presence of any study organism below the hymen and above the hymen and was strongest for GNEs.
  
  
  CONCLUSIONS
  The pattern of genital colonization with enterococci and GNEs reflects their likely gastrointestinal source. The absence of significant differences in the prevalence and cell densities of study microflora above and below the hymen combined with an above-chance association of the presence of microorganisms at these regions suggests that the regions above and below the hymen are not different with respect to the presence of the organisms evaluated in this study.
authors.affiliation: The Procter & Gamble Company, 6110 Center Hill Road, Cincinnati, OH 45224, USA. hochwalt.ae@pg.com
authors.forename: Anne E
authors.initials: AE
authors.lastname: Hochwalt
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Berg
authors.forename: Sandy J
authors.initials: SJ
authors.lastname: Meyer
authors.forename: Rachelle
authors.initials: R
authors.lastname: Eusebio
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology*; D002452:Cell Count; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006801:Humans; D006924:Hymen / Q000382:microbiology; D008597:Menstrual Cycle / Q000502:physiology; D052576:Menstrual Hygiene Products / Q000009:adverse effects / Q000382:microbiology*; D008875:Middle Aged; D015995:Prevalence; D011336:Probability; D018570:Risk Assessment; D012494:Sampling Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D018709:Statistics, Nonparametric; D014621:Vagina / Q000382:microbiology*; D015003:Yeasts / Q000302:isolation & purification*