Invasive group A Streptococcus associated with an intrauterine device and oral sex

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. Goal: The goal was to increase physicians' awareness of oral sex as a risk factor for transmission of invasive GAS disease. Study Design: 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. Conclusion: Because the couple practices oral sex, it was postulated that this was the mode of transmission of the GAS.