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Toxic shock syndrome

Toxic Shock Syndrome (TSS) was discovered in XX century in some women who used old models of tampons (first tampon experiences).

News appeared in public news in 1980s. Since then manufacturers changed dramatically the tampon production and the number of cases of TSS has dropped significantly. Other causes for toxic shock syndrome include the use of contraceptive diaphragms and vaginal sponges (by women), as well as wound infections.

You’ve probably heard of this disease before, and how it may be connected to tampon use. TSS (Toxic Shock Syndrome) is an infection that is very rare, but potentially dangerous. TSS occurs most frequently in young women who wear tampons. You will probably never get TSS, but it’s good to know what the symptoms are and how to avoid putting yourself at risk.

Tampons themselves do not cause TSS. TSS is caused by bacteria called Staphylococcus aureus. If the tampon is left inside of vagina for too long, it creates the perfect environment for different types of bacteria, including Staphylococcus aureus, to grow.

What causes TSS?

Some tampons can trigger Toxic shock syndrome (TSS)

Some tampons can trigger Toxic shock syndrome (TSS)

Toxin-producing strains of Staphylococcus aureus causing toxic shock syndrome was first formally described in 1978. Prior to this time the syndrome was known as staphylococcal scarlet fever. Both menstrual and non-menstrual forms of toxic shock syndrome are caused by these toxins, which release massive amounts of cytokines (cell-mediator chemicals) that produce fever, rash, low blood pressure, tissue injury and shock.

In the late 1980s a disease that showed similar signs and symptoms to toxic shock syndrome but was caused by toxins released by toxin-producing strains of Streptococcus pyogenes, was discovered. This disease although sometimes also referred to as toxic shock syndrome is more correctly known as streptococcal toxic shock-like syndrome (STSS) or toxic strep.

How do you get Toxic shock syndrome?

Toxic shock syndrome starts from a localised staphylococcal infection which produces the causative exotoxins. About 15-40% of healthy humans are carriers of Staphylococcus aureus, that is, they have the bacteria on their skin without any signs of infection or disease (colonisation). However, individuals whom have not developed antibodies against Staphylococcus aureus may develop toxic shock syndrome. In addition, toxic shock syndrome may occur as a complication of other localised or systemic infections such as pneumonia, osteomyelitis, sinusitis, and skin wounds (surgical or burns), where Staphylococcus aureus infections may develop. In these situations the patient has increased susceptibility to developing toxic shock syndrome.

Toxic shock syndrome prevention

To avoid developing TSS, follow these guidelines when using tampons:

  • Change your tampons at least every 4-8 hours or more often if necessary
  • Choose the correct tampon absorbency
  • Use smaller sized tampons when your flow is lighter
  • TSS occurs more often when super-absorbent tampons are used. Don’t use these unless your menstrual flow is particularly heavy
  • Alternate between pad and tampon use. You might want to use pads at night, and tampons in the daytime
  • Wash your hands before inserting or taking out your tampon
  • Don’t use tampons to absorb anything other than your menstrual flow. Only insert a tampon once menstrual blood is present.

If you experience the following symptoms while wearing a tampon, remove the tampon, and contact your health care provider immediately!

Toxic shock syndrome Symptoms

  • Sudden high fever
  • Low blood pressure
  • A sunburn-like rash (widespread red flat rash)
  • Shedding of skin, especially on palms and soles, 1-2 weeks after onset of illness
  • Diarrhea
  • Dizziness, fainting, or lightheadedness
  • Vomiting
  • Severe muscle pain
  • Disorientation or confusion
  • Bruising due to low blood platelet count
  • Red eyes, mouth and vagina due to increased blood flow to these areas

Mentioned symptoms could seem similar to the ordinary flu. If they occur while you are menstruating and wearing a tampon – it could be TSS signals!

It is strongly recommended to visit your doctor!

Women who have had TSS should avoid using tampons during menstruation as re-infection may occur. The use of diaphragms and vaginal sponges may also increase the risk of toxic shock syndrome.


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