Toxic Shock Syndrome
Rare Disease Primarily Caused By Tampons

Toxic Shock Syndrome

Contents

• What Is Toxic Shock Syndrome?
• What Are The Symptoms?
• Diagnosis
• What Are The Risk Factors?
• How Is It Treated?
• Prognosis
• Prevention

Statistics

The CDC has stopped tracking TSS rates since 1987. The rate then was 1 to 2 occurrences per 100,000 women aged 15-44 years of age.

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What Is Toxic Shock Syndrome?

This is a rare but severe disease that affects many of the systems of the body. It is caused by the bacteria Staphylococcus aureus which is often present in the vagina and other parts of the body, but usually causes no harm. Although Toxic Shock Syndrome (TSS) can occur in both women and men of any age, most cases are still associated with menstruating women who use tampons. This fact came to light in the 1980s after a significant number of healthy young women suddenly developed TSS, some even dying from it. When the small epidemic was reported to the CDC (Centers for Disease Control), the numbers started to decline. This may partly be because the public became more aware of the symptoms and sought earlier treatment, but it was probably more to do with precaution steps taken by tampon manufacturers. The original brand of tampon associated with TSS (‘Rely tampons’ by Procter and Gamble) was removed from the market and since then certain materials which were added to tampons to increase absorbency are no longer used. Nevertheless TSS still occurs in 1-2 out of every 100,000 menstruating women, and half of those cases are attributed to tampon use. TSS can also occur in those with skin infections, burns and people recovering from surgery.

What Are The Symptoms?

• High fever (over 38.9 °C /102.02 °F).
• Sunburn type rash which appears on the feet and hands. Skin peels one to two weeks later.
• Headaches.
• Muscle aches.
• Bloodshot eyes.
• Nausea and/or vomiting.
• Diarrhea.
• Dizziness and possibly fainting.

Some of the early symptoms of TSS can be confused with flu, but it can quickly develop into life-threatening complications. Blood pressure can suddenly drop and result in serious shock and sometimes unconsciousness (hypotension). Liver and kidney failure can also occur.

Diagnosis

There is no single test that will diagnose TSS. A diagnosis is usually given based on the presence of typical symptoms, primarily fever, rash and low blood pressure (hypotension). Any woman displaying signs of TSS and who has a tampon inserted should remove it instantly and contact their doctor. The doctor will probably examine the vagina to look for signs of inflammation suggesting a reaction. Other STD tests may be carried out, including those for chlamydia and gonorrhea which can produce very similar symptoms to TSS.

What Are The Risk Factors?

Tampon Use
Although all women who use tampons are at risk of TSS, research shows that those who use super absorbent types are more at risk. Scientists are still not quite sure why this should be, but it is probably something to do with the extra absorbency material providing a good breeding ground for bacteria. Also, chemicals used for increasing the absorbency may irritate the vaginal wall, allowing bacteria to enter the bloodstream in the process.

Previous Infections
Women and teenagers who have previously experienced TSS are at increased risk for recurrence.

Contraceptive Use
Women who leave contraceptive diaphragms or sponges in the vagina for more than 24 hours increase their risk of TSS.

Other Cases
About 30 percent of TSS cases occur in men and children as well as women who do not use tampons. The most common instances are in those recovering from surgery or infections, particularly vulnerable are the old and young. Women during childbirth are also prone.

How Is It Treated?

Any 'foreign' materials inserted in the body such as tampons or contraceptives should be removed instantly. The vagina will be cleansed with Betadine, an antiseptic solution to reduce colonization of the bacteria which is producing the toxin. If the bacteria entered the bloodstream through a surgical wound, the wound will be drained. TSS is then treated with antibiotics; these may be administered orally or through IV. If an IV is used, fluids to combat dehydration will also be given. In severe cases where kidney damage has occurred, dialysis will be necessary.

Prognosis

TSS is a fatal disease causing death in 5 percent of cases. The majority fortunately usually recover within 2 to 3 weeks. However, unlike many diseases, people who experience TSS do not develop immunity which means a recurrence is an ongoing danger. If you undergo surgery in the future, always advise your medical team that you had TSS in the past. It is also best to avoid use of tampons and other internally worn contraceptives. Fortunately as TSS is so rare, most primary care physicians will never see a case in their medical careers. Future fertility does not appear to be affected in women who suffer the disease, but it is important to tell your ob/gyn that you previously had TSS. Any delivery will need to be monitored closely as TSS can recur during delivery and childbirth.

Prevention

The risk of TSS can be reduced by using the lowest possible absorbency tampons, or alternating tampons with sanitary napkins (towels). Since menstrual blood varies in volume, this may mean using 2 or 3 different absorbencies during a period. Fortunately the CDC has now mandated standardized absorbency ratings on all tampon boxes, so choosing the correct one is much easier. One way to know if the absorbency of a tampon is too high is to pull it out after 4 hours. If it slides out easily, the absorbency is correct. If there are still white areas and it is difficult to remove, then the absorbency is probably too high.

If you do use tampons, remember to:

• Always wash your hands before and after inserting one.
• Change tampons regularly as directed on the pack.
• If using tampons at night, change it before going to bed and first thing in the morning.
• Never insert more than one tampon at a time.

Related Articles on Toxic Shock Syndrome

For other guides, see the following:

• Treatment for PMS
• Premenstrual Dysphoric Disorder

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