Toxic Shock Syndrome: Tampons and More

Toxic shock syndrome (TSS) usually strikes women. While it can be extremely serious, it is also quite rare. Often associated with tampon use, TSS is caused by a toxin released by Staphylococcus aureus ( S. aureus). Although TSS can affect anyone, most cases occur in teenage girls and menstruating women. Some cases have been related to exposure to a Staphylococcus infection contracted during surgery or after suffering a burn or open wound. Although most people have naturally occurring antibodies that protect them from this toxin, some do not, and it is in these people that infection by S. aureus bacteria can lead to TSS.

The Tampon-TSS Connection

In the late 1970s, tampons—especially the super-absorbent type—were linked to an increased susceptibility to TSS, especially in women under age 25. Although the exact relationship between tampon use and TSS is still not known, it is believed that tampons may cause very small cuts, lacerations, or ulcerations in the vaginal wall, which make it easier for bacteria to enter into the bloodstream.

Symptoms Occur Suddenly

The symptoms of TSS, which almost always come on very suddenly and occur in women, usually strike during or following a menstrual period. These symptoms include:

• High fever (102°F [39°C] or higher)
• Chills
• Rash (usually looking like a sunburn)
• Diarrhea and/or vomiting
• Drop in blood pressure
• Sore throat
• Abdominal pain
• Headache
• Blood-shot eyes
• Dizziness or fainting
• Muscular aches and pains
• Confusion
• Agitation
• Sleepiness
• Rapid pulse
• Vaginal discharge (may be watery or bloody)
• Swelling in the face and eyelids
• Peeling of the skin on the palms or soles
• Extreme fatigue and/or weakness

While relatively rare, TSS can lead to serious complications, especially if left untreated. TSS can lead to shock, kidney and/or liver failure, paralysis, and miscarriage. In a very small number of cases, death can result from hypotensive shock. The body's reaction to the toxins can be overwhelming—blood pools near the digestive tract, causing the heart and lungs to be deprived of blood and to stop working.

Diagnosis: Distinguishing TSS From Similar Illnesses

"Most of the symptoms caused by TSS can also be caused by other conditions or diseases, such as Rocky Mountain spotted fever and measles," says Jacques Carter, MD, general internist and public health specialist at Boston's Beth Israel Deaconess Medical Center. "However, when a high fever and a number of the other symptoms associated with TSS suddenly strike during or soon after a woman's menstrual period, doctors will generally suspect TSS and begin treatment while simultaneously searching to see if another condition or disease is the underlying cause. In addition, doctors will, in many cases, order a lab culture of the vagina, which can often detect the presence of S. aureus."

Urgency: Treating TSS Immediately

While the treatment for TSS is relatively simple, it must be implemented quickly. Therefore, it is critical that any woman who is suddenly struck with a high fever and one or more of the other symptoms associated with TSS during or soon after a menstrual period immediately remove her tampon (if still present), and then call her doctor to seek medical attention.

Treatment can include:

• Large amounts of fluids (intravenously if necessary) to keep hydrated and control the effects of the fever
• Antibiotics to help control the infection
• Medicines to control and reduce the fever, as well as aches and pain

In severe cases, a patient may be hospitalized to allow the doctor to more closely monitor and, if necessary, treat for the possible complications that might develop (ie, shock, kidney failure, or liver failure).

Prevention: The Best Bet

Like most medical conditions, the best treatment for TSS is prevention. To that end, all women should take the following preventative measures:

• Wash your hands before inserting a tampon.
• Use tampons with as low a degree of absorbency as is practical, and don't use super-absorbent tampons unless instructed to do so by your doctor.
• Change your tampon every 4-8 hours.
• Do not leave a tampon in overnight.
• When practical, use a pad instead of a tampon.

Finally, though TSS is not contagious, it can strike the same person more than once. If you've had TSS before, don't use tampons again without first getting approval from your doctor.