Toxic shock syndrome (TSS) is a rare condition that affects men, women and children. Two types of bacteria cause it: staphylococcus aureus and streptococcus pyogenes. These invade the body via the bloodstream releasing poisonous toxins that lower blood pressure and damage vital organs. If left untreated, it is life threatening and can cause kidney failure.
NHS statistics show that out of a UK population of 60m there are around 40 reported cases of TSS each year. Two or three people will die from it so it's a rare illness but fatal and important to know about.
Causes of Toxic Shock Syndrome
Non-Menstrual TSS
Staph and strep bacteria live on the skin in a third of people without causing any harm and most of us have a strong enough immune system to fight off any toxins that get into the bloodstream. Teenagers are more susceptible because their bodies haven't yet built up sufficient immunity (antibodies) to fight it. The bacteria can enter the bloodstream via an infected wound or boil, insect bites, burns, nipple or genital piercings, or after a bout of illness when the immune system is low. Good hygiene and aftercare are an important part of prevention.
Menstrual TSS
Controversially, half of the reported cases in the UK have been linked to the use of tampons (UK Public Health Laboratory Service 1985-1995), in particular high absorbency brands made with synthetic additives (rayon wrapped in plastic to prevent shedding). In August 1978, Procter & Gamble launched Rely tampons in the US. This was a super-absorbent brand that supported 20 times its own weight in fluid. TSS was first identified that year amongst teenage girls and reached a peak during the summer of 1980 with 813 cases and 38 deaths reported to the Centers for Disease Control and Prevention (CDC).
The CDC investigated the outbreak and linked TSS to the use of super-absorbent tampons, saying that women who used Rely were at increased risk. On 22nd September 1980, P&G recalled the brand and issued a statement to consumers about the potential health problems. They weren't alone, as other super-absorbent brands were causing similar problems around the US.
Some women are sensitive to the chemicals and dioxin in tampons. The levels used may be low but the effects are accumulative and given that tampons tend to be used long-term, they may pose a health risk. One theory behind menstrual TSS is that the fibres in tampons cause tiny abrasions in the mucous membranes of the vagina, allowing bacteria into the bloodstream. The vagina is also a warm, moist environment so breeding ground for bacteria.
Myths About Toxic Shock Syndrome
In a TV interview* with Katie Gotham, a 15-year old girl who contracted TSS whilst on holiday, Dr. Dawn Harper, an expert in women's health, said: “Toxic shock can happen to anyone. About half the cases are in menstruating women but it can affect men and children. There is a link between using any tampons – using an organic brand doesn't seem to make a difference, and also some forms of contraception such as the diaphragm. However, tampons are safe for the vast majority of people and most GPs will never see a case of TSS in their entire professional lives."
Dr. Carol Livoti, a NY-based gynaecologist and author of Vaginas: An Owner's Manual says: “The vast majority of TSS has nothing to do with tampons and vaginas. Men get it. Postmenopausal women get it. And if you’ve forgotten a tampon and left it in for longer that you would have liked, the odds of your getting TSS remain very close to zero.”
Signs and Symptoms of TSS
TSS is fast acting and produces flu-like symptoms that are a type of blood poisoning. The toxin develops two hours after a tampon is inserted and will continue to multiply even if the tampon is changed regularly:
- a sudden high temperature (above 38 °C or 100.4°F)
- a skin rash around the neck (later stages of TSS)
- redness around the eyes, throat and tongue
- vomiting and diarrhoea
- dizziness, fainting or confusion (caused by a drop in blood pressure)
- muscular aches and stomach pain
- headache
Testing and Treatment
There is no single test to diagnose TSS but a doctor will assess the symptoms and check whether the vital organs are functioning properly by taking blood and urine samples. TSS will be diagnosed if someone has most of the above symptoms and their vital organs have been affected. Antibiotics are used to treat TSS, which will have an effect within a couple of days. Immunoglobulin (blood containing high amounts of antibodies) is sometimes given to help the body fight the bacteria.
There is a TSST-1 antibody test which will check if a girl has the right antibodies to enable her to use tampons containing viscose-rayon. Not all hospitals offer this so it's worth doing some research to find out if it's available locally.
Preventing Toxic Shock Syndrome
TSS can recur and antibiotic treatment doesn't give you immunity. If you've had it or have experienced a bad reaction to internal menstrual devices or contraception, you will need to consider alternatives. I had a bad reaction to a menstrual cup, feeling sick, dizzy and faint for 10 minutes after insertion. I reported this to the manufacturer's nurse advisor and was told that this can sometimes happen if you knock the cervix during insertion, as it triggers the nerves. My body has reacted this way before when I've tried to use tampons so I wonder if it is a mild form of TSS or just that my body isn't suited to internal menstrual and contraceptive devices. There have been no reported cases of TSS and menstrual cups but for my own peace of mind I will seek medical advice.
TSS is a serious illness but if treated promptly with antibiotics the prognosis is good and there are no long-term complications. Practice good hygiene: treat wounds promptly and always wash your hands before inserting a menstrual device. Philip Tierno Jr. M.D, Chief of Clinical Microbiology and Immunology at the New York Medical Center advocates using all-cotton tampons or sanitary pads rather than brands containing rayon and plastics. Change them frequently and alternate with sanitary pads to enable any toxin that has built up to dissipate.
Sources:
- *Toxic Shock Information Service: Video excerpt from ITV’s 'This Morning' – an interview with Katie Gotham and Dr. Dawn Harper (aired 9th June 2009) and 'Toxic Shock Syndrome: A Health Professional’s Guide' by Robert L Deresiewicz (accessed 26.03.11)
- NHS Choices 'Toxic shock syndrome.' (accessed 26.03.11)
- Thekeeper.com: 'What's Wrong With Tampons?' (accessed 29.03.11)
- Vaginas: An Owner’s Manual by Dr. Carol Livoti and Elizabeth Topp, Fusion Press 2005.
- Facebook page links in memory of Amy Rae Elifritz who died of TSS aged 20 after using regular absorbency Playtex tampons.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
Nicci Talbot - Nicci Talbot is a journalist and author specialising in sex, health & wellbeing. She edits Rude Magazine, an online resource for better ...
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