Toxic Shock Syndrome
Toxic shock syndrome (TSS) is a rare but life-threatening illness that
is caused by bacterial toxins (poisons) that circulate in the
These toxins are produced by certain bacteria when they infect certain parts of the body.
TSS is often associated with the use of tampons by menstruating women,
you should be aware that it also occurs in different situations besides
People with toxic shock syndrome develop high fever,
rash, low blood pressure, and failure of multiple organ systems in the
In this article, I will discuss the causes, symptoms,
treatment and prevention of TSS in general but especially with regards
to menstruating women using tampons.
Causes and Statistics
Toxic shock syndrome often results from toxins produced by
Staphylococcus aureus (staph) bacteria. A similar syndrome, called toxic
shock-like syndrome (TSLS), can be caused by Streptococcal
bacteria.These organisms infect an area of the body, grow and produce
toxins which circulate in the blood stream and cause severe disease.
the earliest cases of TSS involved women who were using superabsorbent
tampons during their periods (menstruation), today less than half of
current cases are associated with such events. Toxic shock syndrome can
also occur with skin infections, burns, and after surgery. The condition
can also affect children, postmenopausal women, and men.
statistics are rare on this subject. However, in the US, about 5296
cases of Staphylococcal TSS were reported from 1979-1996. About 1 woman
in 100,000 is estimated to develop menstrual Staphylococcal
TSS.Streptococcal TSS occurs less commonly than Staph TSS.
early 1980s, about 5.5% of women who developed the menstrual
staphylococcal TSS died even with treatment. However, this has dropped
significantly to 1.8% in 1996.
Risk factors/causes include:
- Tampon use. Superabsorbent tampons and leaving the tampons in the vagina for a long time especially when used overnight.
- Staphylococcus aureus (S. aureus) infection, commonly called a Staph infection
- Foreign bodies or packings (such as those used to stop nosebleeds)
- Use of barrier contraceptives such as a diaphragm or vaginal sponge
- Wound infection after surgery
A Brief History
The term toxic shock syndrome was first used by a
pediatrician, Dr. James K. Todd( Denver, USA) to describe the
staphylococcal illness in three boys and four girls aged 8–17 years .
toxic shock syndrome did not become familiar until an epidemic in 1981,
linked to women using superabsorbent tampons( Rely). It is noted that
was in response to women's demand to have a superabsorbent tampon that
can absorb most of the menstrual flow. This created a sudden rise in the
incidence of TSS which was rapidly successfully curtailed by the
Centers for Disease Control and Prevention.
They may be sudden in some cases. Common symptoms include
- General ill-feeling
- High fever, sometimes accompanied by chills Low blood pressure
- Muscle aches
- Nausea and vomiting
- Organ failure (usually kidneys and liver)
- Redness of eyes, mouth, throat
red rash that looks like a sunburn -- skin peeling occurs 1 or 2 weeks
after the rash, particularly on the palms of the hand or bottom of the
There's no one specific test for this syndrome. Your doctor
may have to look for an evidence of infection using blood and/or urine
samples. Samples from the vagina, cervix and throat may be swabbed for
In the case of a menstruating women, a
diligent search for a tampon in the vagina may be the biggest clue to
the diagnosis. The stories of women with lost tampons or tampons stuck inside the vagina are amazing.
the case, the diagnosis of TSS is not made at home. You need to be
evaluated by your doctor because it may progress rapidly with
devastating consequences if diagnosis and appropriate treatment are
TSS requires hospitalization. The mainstay of treatment is antibiotics
but supportive treatment will be given depending on what the precise
cause requires e.g. fluids for low blood pressure, local toileting for
vaginal infection, dialysis for serious kidney failure and etc.
Though the average dead is now about 1.8% for staphylococcal TSS, it
may deadly in up to 50% of cases. The condition may return in those that
With proper treatment, patients usually recover in two to three weeks. The condition can, however, be fatal within hours.
In response to the epidemic of 1981, tampon use has been highly
regulated. The US FDA has spelled out guidelines to help women who use
tampons to avoid TSS. The "thing" about the use of tampons is that these
guidelines are easily taken lightly by some women or can easily be
forgotten as much as they tampons themselves can easily be forgotten
inside the vagina! Therefore, be cautious to make sure you adhere to
these simple guidelines
- Follow package directions for insertion
- Choose the lowest absorbency needed for one's flow
- Consider using cotton or cloth tampons rather than rayon
- Change the tampon at least every 4 to 6 hours
- Alternate between tampons and pads
- Avoid tampon usage overnight when sleeping
- Increase awareness of the warning signs of toxic shock syndrome and other tampon-associated health risks
Return From Toxic Shock Syndrome To Menstruation Home