Hormonal Contraceptive Use and Persistent Staphylococcus aureus Nasal Carriage

Background. Human nares colonized with Staphylococcus aureus are the most important reservoir for this pathogen. We studied the influence of sex and hormonal contraceptive use on persistent S. aureus nasal carriage. Methods. We conducted a cohort study in healthy volunteers and determined carriage status at baseline and again at follow-up by using the results of 2 swab samples at each time point. We applied logistic regression to analyze associations of interest. Results. At baseline, 266 of 1180 volunteers (22.5%) were classified as persistent nasal carriers. Compared with women not using hormonal contraceptives, women taking reproductive hormones (odds ratio [OR]. 1.88; 95% confidence interval [CI], 1.29-2.75; P = .001) and men (OR., 1.57; 95% CI, 1.08-2.28; P = .02) were more likely to be persistent carriers. These associations remained stable after adjusting for known risk factors of nasal carriage. Women taking hormonal contraceptives and being persistent carriers at baseline were more likely to remain carriers after a median follow-up time of 70 days than women not using such medication (OR, 3.25; 95% CI, 1.44-7.34; P = .005). No patterns of association could be observed between persistent carriage among women and type of progestin or dose of estrogen used. Assuming causality and using estimates from multivariable logistic regression, we approximated that 20% (95% CI, 2.4%-34.9%) of persistent nasal carriage among women represented by our sample is attributable to hormonal contraception (population-attributable fraction). Conclusions. The widespread use of hormonal contraception may substantially increase the human S. aureus reservoir with potential impact on S. aureus infection and transmission.