What You Need to Know About Toxic Shock Syndrome

Toxic Shock Syndrome (“TSS”) is a rare but potentially fatal medical condition that is caused by bacteria that produce toxins in the body.

The first cases of TSS were identified in 1978 in a group of children. In the 1980s, cases of TSS were found among women using tampons during their menstrual periods. While people most commonly associate TSS with tampon use, the risk of getting TSS from tampons has significantly declined over the past twenty years after manufacturers took certain types of tampons off the market and the FDA and tampon manufactures provided more informative TSS warning labels and increased educational efforts.[1] Anyone can contract TSS—in fact, 50 percent of cases of TSS are non-menstrual. Men, children, and women who are not on their menstrual cycle or post-menopausal women can also contract TSS.[2]

What causes TSS?

There are three main types of bacteria than can cause TSS: staphylococcus aureus, clostridium sordelli, and streptococcus pyogenes. These types of bacteria often live on our skin or in our mucous without making us sick; however, certain conditions can catalyze these types of bacteria to rapidly grow, producing toxins that can cause this serious, potentially fatal illness.

What are the risk factors for contracting TSS?

• Having cuts, burns, or open wounds on your skin;
• Having had recent surgery;
• Using contraceptive sponges, diaphragms, or tampons; and
• Having a viral infection (i.e., the flu or chickenpox)

How do you get TSS from tampons?

Bacteria may become trapped in the vagina when tampons are used and can enter the uterus via the cervix. Also, tampons can cause tiny cuts in the vagina, which then allow the bacteria to enter the body via the bloodstream. The higher the absorbency of the tampon, the higher the risk factor for TSS—accordingly, you should use a tampon with the minimum absorbency necessary to control your menstrual flow.[3] Bacteria may grow on tampons, especially if they are not changed often enough. You should change your tampon every four to eight hours. As such, if you are sleeping for longer than 8 hours, you should use a pad instead of a tampon to reduce your risk.[4]

What are the symptoms of TSS?

According to The Cleveland Clinic, the onset of TSS symptoms is usually sudden and symptoms may vary depending on the type of bacteria that are producing the toxins. Symptoms of TSS may include but are not limited to:[5]

• Nausea or vomiting;
• Sudden high fever and chills;
• Watery diarrhea;
• Rash resembling a bad sunburn or red dots on the skin;
• Dizziness, light-headedness or fainting.
• Low blood pressure;
• Redness in the eyes;
• Peeling of the skin or a rash resembling a sunburn on the soles of the feet or palms of the hands or a rash resembling a sunburn, particularly on your soles or palms;
• Seizures;
• Headaches; and/or
• Muscle aches

When to seek medical attention?
If you have signs or symptoms of TSS, seek out medical attention immediately. This is especially important if you’ve recently used tampons or if you have a skin or wound infection. While TSS is rare (in 2015, only 337 cases of TSS were reported in the U.S.), it’s better to air on the side of caution and be safe rather than sorry.[6]

How is TSS Diagnosed?

A medical provider will perform blood tests to rule out other viral or bacterial culprits that can cause symptoms similar to TSS. Also, women will have a pelvic examination where tissue cultures will be taken from the vagina and the cervix to be tested for the presence of TSS-causing bacteria. If you have a wound or skin infection, tissue cultures will be taken at the wound site.[7]

How is TSS Treated?

Because of the potential severity and life-threatening nature of TSS, patients with TSS need to be hospitalized and under medical supervision. Treatment may include intravenous fluids, blood pressure medication, intravenous antibiotics, and other treatments to boost the immune system such as infusions of immune globulins.[8]

What are the medical complications of TSS?

TSS can progress rapidly. The earlier TSS is diagnosed and the patient begins treatment, the better the potential outcome. Worst-case TSS complications include shock, renal and organ failure, gangrene, amputation of limbs, coma, and death.[9]

At Women’s Pelvic Surgery, board certified uro/gyn Dr. Khashayar Shakiba and his staff are dedicated to helping you stay healthy at all stages of your life. For more information about the comprehensive gynecology services we provide, check out our website. If you have any questions or want to schedule an appointment, call us at (201) 301-2772 or click here to contact us online.

[1] https://www.fda.gov/MedicalDevices/ucm071781.htm

[2] https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome

[3] http://www.playtexplayon.com/tampon-faq/tss-information

[4] https://www.teenvogue.com/story/toxic-shock-syndrome-7-things

[5] https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome

[6] https://www.cbsnews.com/news/lauren-wasser-model-lost-her-leg-tss-toxic-shock-syndrome/

[7] https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome/diagnosis-and-tests

[8] https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome/management-and-treatment

[9] https://www.mayoclinic.org/diseases-conditions/toxic-shock-syndrome/symptoms-causes/syc-20355384