Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a rare but life-threatening condition caused by bacterial toxins. It is a sudden and potentially life-threatening condition triggered by an overgrowth of bacteria releasing toxins into your bloodstream. While uncommon, TSS can affect anyone, including men, children, and even postmenopausal women.

Experiencing toxic shock syndrome (TSS) can initially feel like having the flu, but it escalates rapidly as the toxins from the infection begin damaging your organs. Pay close attention to symptoms such as a sudden high fever and vomiting, especially if you’re menstruating or have an open wound or skin infection. If you’re using a tampon, menstrual sponge, diaphragm, or cervical cap when you start feeling sick, it’s crucial to remove it immediately, even before contacting your doctor.

What causes Toxic shock syndrome?

TSS can be caused by three different types of bacteria:

1. Staphylococcus aureus (staph)
2. Streptococcus pyogenes (group A streptococcus)
3. Clostridium sordellii

Staph bacteria commonly reside harmlessly on many people’s bodies, but they can lead to infections in individuals with severe burns or those who have undergone surgery. Group A strep typically causes less severe infections like strep throat and impetigo. Clostridium sordellii may also inhabit the vagina without causing harm.

TSS occurs when specific conditions allow these bacteria to multiply rapidly and release toxins, which then enter the bloodstream through breaks in the skin or mucous membranes. Factors that can contribute to TSS include:

• Skin wounds or infections: Bacteria can enter through breaks in the skin.
• Surgery: Recent surgeries can create an entry point for bacteria.
• Gynecological procedures such as childbirth or abortion
• Tampon use: While tampon materials and designs have improved, tampon use can still be a risk factor.
• Other menstrual products, such as menstrual cups, sponges, and diaphragms, can also increase risk, though less commonly than tampons.
• Viral infections: Having the flu or chickenpox can weaken your immune system, making you more susceptible to bacterial infections.

Why tampoons cause Toxic shock syndrome

Tampons can contribute to toxic shock syndrome (TSS) for several reasons:

1. Bacterial Growth: Tampons, especially super-absorbent ones, provide an environment where bacteria can rapidly multiply, particularly if the tampon becomes fully saturated. This bacteria can then travel into the uterus through the cervix.
2. Prolonged Use: In some instances, TSS has occurred when tampons, menstrual sponges, diaphragms, or cervical caps have been left in the vagina for an extended period, exceeding 30 hours. Extended use increases the risk of bacterial growth and toxin production.
3. Material Composition: The material of the tampon can also influence the risk of TSS. Polyester foam tampons have been associated with a higher risk compared to those made of cotton or rayon fibers.
4. Vaginal Tears: Inserting a tampon can potentially cause microscopic tears in the vaginal walls, providing an entry point for bacteria. Additionally, leaving a super-absorbent tampon in for too long or using it when the menstrual flow is light can dry out the vagina, increasing the likelihood of tearing.

It’s worth noting that the types of super-absorbent tampons implicated in TSS cases from the late 1970s and early 1980s are no longer manufactured. Furthermore, tampon manufacturers are now required to adhere to standard labeling and measurements for absorbency, as well as include instructions for safe usage. As a result, the number of TSS cases related to tampon use has declined significantly since the 1980s.

Risk Factors

Certain situations can increase your risk of developing Toxic Shock Syndrome (TSS):

• Tampon Use: Particularly with super-absorbent tampons or if they’re left in longer than recommended.
• Skin Breaks: Having broken skin due to cuts, burns, or insect bites provides an entry point for bacteria.
• Post-Surgery: Individuals recovering from surgery are at a heightened risk.
• Skin Infections: Conditions like impetigo or cellulitis increase susceptibility to TSS.
• Other Infections: Having strep throat, the flu, chickenpox, or other viral infections can elevate the risk.
• Gynecological Events: Recent childbirth, miscarriage, or abortion can increase vulnerability.
• Use of Vaginal Devices: Using a diaphragm or other vaginal devices can contribute to TSS risk.
• Nosebleeds: Needing gauze packing to stop nosebleeds can also be a risk factor.
• Previous TSS: Individuals who have had TSS in the past are more prone to experiencing it again.
• Age and Health Status: Very young or old individuals, those with weakened immune systems, or those with chronic medical conditions face a higher risk of TSS.

Warning Signs of TSS

TSS symptoms develop rapidly. Be on the lookout for:

• Sudden high fever
• Low blood pressure
• Vomiting or diarrhea
• A sunburn-like rash, especially on palms and soles
• Confusion
• Muscle aches
• Redness of the eyes, mouth, and throat
• Seizures
• Headaches

Diagnosis of Toxic shock syndrome

To diagnose Toxic Shock Syndrome (TSS), doctors employ several methods:

1. Blood and Urine Samples: These are tested to detect the presence of staph or strep infections, the common culprits behind TSS.
2. Swabs: Swabs are taken from the vagina, cervix, throat, or any infected wounds to check for bacterial presence.
3. Blood Tests: Your blood is analyzed for cell counts and enzyme levels, providing insights into the functioning of your organs. Abnormalities in these levels can indicate TSS.
4. Clotting Assessment: Doctors measure how quickly your blood clots, as abnormal clotting can be a sign of TSS.
5. Imaging Tests: Imaging tests such as CT scans, spinal taps, or chest X-rays may be conducted to assess any organ damage or other signs that TSS is affecting your body.

By combining these diagnostic methods, healthcare professionals can accurately identify and diagnose Toxic Shock Syndrome, enabling prompt treatment and management of the condition.

Seek Immediate Medical Attention!

If you experience any of these symptoms, especially after using tampons or having a skin infection, call your doctor right away. Early diagnosis and treatment are crucial in preventing serious complications.

Complications of TSS

Left untreated, TSS can progress rapidly and lead to:

• Shock: A life-threatening condition where your organs don’t receive enough blood flow.
• Kidney failure: The toxins from the bacteria can damage your kidneys.
• Death: In severe cases, TSS can be fatal.

Prevention Tips

Here’s how to minimize your risk of TSS

• Choose tampons wisely. Opt for the lowest absorbency level that works for you and change them frequently (every 4–8 hours). Consider alternating tampons with pads or using mini-pads during lighter flow days.
• Maintain proper hygiene: Keep your skin clean and address any wounds promptly.
• Be aware of your body: If you experience unusual symptoms after using tampons, switch to pads and consult your doctor.

Treatment for TSS

Treatment for Toxic Shock Syndrome (TSS) is urgent and typically requires hospitalization. Here’s what you can expect:

• Intravenous Antibiotics: Doctors Administer Antibiotics directly into your bloodstream through a vein in your arm to combat the bacterial infection causing TSS.
• Antibodies from Donated Blood: In severe cases, antibodies from donated blood may be given to aid in fighting the infection.
• Medication for Low Blood Pressure: Doctors may prescribe Medications to stabilize your blood pressure if it drops dangerously low.
• Fluid Replacement: Intravenous fluids are provided to replenish the body’s lost water and maintain hydration.
• Oxygen Therapy: Extra oxygen may be supplied to ensure adequate oxygenation of tissues and organs.
• Surgical Intervention: If the TSS is caused by severely infected tissue, surgery may be necessary to remove the infected area and prevent further spread of the infection.
• Kidney Support: If TSS leads to kidney damage, dialysis may be required to help with kidney function until they recover.
• By addressing the bacterial infection, stabilizing vital signs, and providing supportive care, hospital treatment aims to manage the symptoms of TSS and prevent complications. Early intervention and comprehensive medical care are crucial for the successful treatment of toxic shock syndrome.

Sources

1. Toxic Shock Information Service
2. Centers for Disease Control and Prevention (CDC)
3. Mayo Clinic: “Toxic Shock Syndrome”
4. Cleveland Clinic: “Toxic Shock Syndrome”
5. CDC: “Streptococcal Toxic Shock Syndrome”
6. StatPearls: “Toxic Shock Syndrome”
7. Johns Hopkins Medicine: “Toxic Shock Syndrome (TSS)”