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CDC reports a rise in TSS cases. (image: daddymould dot blogspot dot com)

The term toxic shock syndrome (TSS) refers to a rare complication from a bacterial infection often resulting in life-threatening consequences. Frequently, TSS occurs from toxins released by the Staphylococcus aureus (staph) bacteria, but the Streptococcus pyogenes (strep) bacteria can also cause the condition. These toxins circulate throughout the bloodstream, causing high fever, rash, multiple organ system failures, and hypotension.

TSS History and Risk Factors 

Physicians first saw the often-fatal condition in children in 1978, but it later became associated with super-absorbent tampons and contraceptive sponges. An epidemic of the condition sprung up in 1981; authorities linked it to women using a certain type of super-absorbent tampons. Healthcare providers see the most common types of TSS in menstruating women; tampon use encourages the proliferation of bacteria that grows naturally in the vagina. Even so, men and postmenopausal women can also become infected. Risk factors, in addition to super-absorbent tampon use, include open skin wounds, nasal packing, childbirth and surgery.

Increase in U.S. TSS Cases 

According to a Minneapolis surveillance group and the Centers for Disease Control, an 18 percent increase in TSS cases occurred in the U.S between 2002 and 2003. Experts theorize that FDA regulation changes in allowable absorbance capacity of tampons could, in part, explain this increase. Prior to 1999, the FDA restricted tampon absorbency rates to 15 grams of fluid or less. In 2000, they relaxed this regulation and allowed manufacturing companies to offer a new ultra-absorbent category of tampons that absorb up to 18 grams of fluid. Additionally, women should change their tampons frequently. No data exists to record the number of TSS cases that occur from failure to change tampons regularly.

TSS Symptoms 

This extremely rare, but potentially fatal condition can have mild symptoms that are never associated with TSS.  The woman may not seek the care of a physician and come out of the syndrome on her own, or of those who seek medical help, the physician may never connect these mild symptoms with TSS. The most severe cases result in organ failure – most often the liver and kidneys, but occasionally the heart. Other symptoms include:

• Vomiting
• High fever
• Sunburn-like rash that causes the palms of the hands and soles of the feet to peel several days after the rash resolves
• Headaches
• Seizures
• General malaise

TSS and Treatment 

Treatment depends upon the severity of the TSS and may include intravenous delivery of antibiotics and other fluids, intravenous gamma globulin, dialysis for kidney failure, administration of medications to control blood pressure.

Considerations and Prevention 

According to the National Institutes of Health, TSS is fatal in up to 50 percent of cases and those who survive should watch out for repeat occurrences. Seek the attention of a physician or go to the nearest emergency room if you develop any of the above symptoms or feel generally ill, especially during menstruation or after surgery. Avoid using superabsorbent tampons and change them frequently. Do not sleep with a tampon inserted. Use a pad instead. Keep surgical wounds clean and follow post-operative instructions carefully.

For more information about issues with menstruation visit Be Prepared Period.