Toxic Shock Syndrome (TSS)

What is Toxic Shock Syndrome?

Toxic Shock Syndrome is an uncommon, but serious illness that was first recognized in the late 1970's. TSS is caused by a toxin (a poisonous protein). The toxin responsible for causing TSS is produced by a bacterium called staphylococcus aureus. This bacterium is found on the skin and mucous membranes of most people, and is usually harmless. While the presence of staphylococcus aureus does not necessarily lead to disease, it can cause problems such as skin infections (boils and abscesses), wound infections, blood infections and some forms of food poisoning.

Even though most cases of TSS have been women under 30 years of age who use tampons (especially "super absorbant" tampons), TSS can also occur in females who do not use tampons and in males. The reasons for the association between TSS and tampon use remain unclear, but the number of reported cases of TSS has dropped quite a bit since super absorbant tampons were taken off the market. Tampon manufacturers have also started to include information about TSS in all tampon boxes. *When TSS occurs in males, or females who don't use tampons, there is usually an association with a staphylococcal infection somewhere in the body (for example - an infected wound or a skin abscess).

How can I reduce my risk of getting TSS?

• You can help to reduce your risk of getting TSS by not using tampons.
• If you use tampons (even those that are not super absorbant):
  • read the instructions and warnings contained in your tampon package carefully and follow the instructions
  • wash your hands well with soap before inserting or removing the tampon insertion
  • change tampons 3 or 4 times during the day (usually every 4-8 hours), and use sanitary napkins at night. NOTE: removing and inserting tampons too often may increase the chance of bacterial infection
  • select a tampon with the lowest absorbency rating possible to control your menstrual flow
  • alternate using tampons and sanitary napkins
  • use sanitary napkins during times when it is unlikely that you will change tampons often (e.g. at night)
  • remove the tampon at once and seek medical attention if you notice the signs of TSS while you are wearing a tampon
• Check with your doctor before using tampons again or using cervical caps, diaphragms or contraceptive sponges if you have had TSS before.
• Speak with your doctor, pharmacist or other healthcare professional if you have questions about TSS or tampon use
• Make sure that any sores or skin wounds are kept clean.
• Report any skin or wound infections that appear to be getting worse, instead of better, to your doctor.

What are the signs and symptoms of TSS?

• sudden high fever
• nausea and vomiting
• diarrhea
• headache
• generalized aches and pains
• dizziness and feeling faint (especially when rising from a lying or sitting position)
• disorientation (confusion)
• a sunburn-like rash on the palms of the hands and the soles of the feet (the skin on these areas generally peels about 1-2 weeks later)
• extremely low blood pressure, rapid weak pulse (shock)

These signs should be reported to your doctor right away -- if you can't reach your doctor, go to the nearest emergency department or call 911.

Complications of TSS may include kidney failure, liver failure and even death ( in about 3 percent of cases ).

How is TSS treated?

Treating TSS usually involves:

• using antibiotics to kill the staphylococcus bacteria that are producing the toxin
• using supportive measures such as intravenous fluids and medications to treat the effects of the toxins (low blood pressure, shock, etc.)
• preventing and treating complications

References

* Kniffin WD Jr, Smith R, Stashwick CA., Journal of Adolescent Health Care, Toxic shock syndrome in three adolescent males. March, 1990, 11(2):166-9.

General reference - The Canadian Medical Association - Home Medical Encyclopedia, Dr Peter Morgan (Editor), The Reader's Digest Association (Canada) Ltd., Montreal, 1992.

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