DEAR DOCTOR K:
I saw a warning about toxic shock syndrome on a box of tampons. What is it, and what does it have to do with tampon use?
Toxic shock syndrome (TSS) is a rare, life-threatening illness triggered by certain bacteria. The two bacteria most often involved are streptococci (“strep”) and staphylococci (“staph”). The cases caused by streptococci tend to be the most severe. In TSS, toxins (poisons) produced by these bacteria cause a severe drop in blood pressure that can lead to organ failure.
Doctors first became aware of toxic shock syndrome back in the 1970s and early 1980s. At that time, several young women using a particular type of tampon died from TSS. (That tampon was later removed from the market.)
Tampon-related cases of TSS have decreased since then, but tampon use remains a risk factor for TSS. Women who develop TSS are more likely to have used high-absorbency tampons, used tampons continuously for more days of their cycle, and kept a single tampon in place for a longer period of time.
Not all cases of TSS are related to tampon use. In some patients, bacteria that cause TSS enter the body through a wound or puncture. The bacteria that cause TSS often live on the skin. When the skin is damaged by an injury, the bacteria can travel from the surface of the skin into the wound. Once they get inside the wound, they can multiply and spread under the skin’s surface.
Sometimes, however, toxic shock develops after a relatively mild injury, even one in which there is no visible injury to the skin. And sometimes no cause is identified.
Symptoms of TSS include:
- Pain, redness, warmth and swelling in an area just below the skin or in a muscle;
- Flu-like symptoms such as fever, chills, muscle aches, nausea, vomiting and diarrhea;
- Low blood pressure with a weak and rapid pulse;
- A red rash that covers the whole body;
- Decreased urine output;
- Confusion or disorientation;
- Swelling in the hands, feet and ankles;
- Severe breathing difficulties.
Shock and other life-threatening symptoms of TSS can develop suddenly. TSS is a medical emergency. Anyone experiencing the symptoms of TSS should be taken to a hospital immediately.
Treatment involves fluids and medicines given intravenously to raise blood pressure and improve blood flow to vital organs. Antibiotics are used to kill the bacteria that are causing the infection and releasing the toxin. If organs begin to fail, a person may need to be connected to machines to keep them alive. If the lungs fail, they may need to be put on a breathing machine. If the kidneys fail, they may need to be connected to a dialysis machine.
Most people with TSS recover completely. Unfortunately, some die — even with prompt treatment in the hospital.
To reduce your risk of developing tissue infections, promptly clean and treat even small skin wounds. To help avoid TSS related to tampon use, change tampons frequently.