What is Toxic Shock Syndrome (TSS)?

You’ve probably heard of Toxic Shock Syndrome at some point. This article will tell you all you need to know about this illness: what it is and what causes it, who can get it, what the symptoms are, what TSS means and how to reduce the risk of getting it.

Causes and basic info

What Is TSS (or Toxic Shock Syndrome)?What Causes TSS?What Has TSS Got To Do With Using Tampons?I’ve Read That With 100% Cotton Tampons You Have A Lower Risk, Or Zero Risk, Of TSS. Is This True?I’ve Read That You Can’t Get TSS When Using A Menstrual Cup, So Why Don’t Women Just Use This?

Symptoms and TSS facts

What Are The Symptoms Of TSS From Tampons?Can Anyone Get TSS?Is TSS Contagious?Is It Possible To Get TSS More Than Once?

Treatements and prevention

What About Toxic Shock Syndrome Treatment?What Should I Do If I Notice These Symptoms?How Can I Lower The Risk Of Getting Menstrual TSS?How Do I Choose A Tampon With The Right Absorbency Rating?

Causes and basic info

Toxic Shock Syndrome (or TSS, for short) is a rare but serious and even life-threatening illness, caused by toxins produced by the bacteria Staphylococcus aureus. Although it’s very rare – cases of TSS are so uncommon that hardly any members of the medical profession come across a single case at any point in their professional careers – it’s important to be aware of the illness so that you can do something about it if necessary. TSS can be diagnosed and treated successfully, but the symptoms must be recognised and treated early.

Toxic Shock Syndrome is an illness that was named and first described in 1978 by Dr. James Todd, based on a study carried out on the clinical cases of 7 children. Similar cases had already been written about in medical literature much earlier, even long before personal hygiene products started to be manufactured. Men, women and children can all suffer from TSS. Although the first cases of toxic shock syndrome to be described mainly affected women who were using tampons during their periods, less than half of the current cases are associated with this practice nowadays. This syndrome can also occur with skin infections, burns and after surgery. The illness can also affect children, post-menopausal women and men.

TSS is caused by certain toxins produced by the bacteria Staphylococcus aureus. These bacteria are micro-organisms that, like many other bacteria, are naturally found in the bodies of healthy people, usually on the skin, in the nose, armpits, groin and vagina. In fact, almost a third of the population has these bacteria in their bodies without them causing any health problems. In a very small number of people, certain strains of this organism produce a toxin that can cause TSS. Most people have antibodies in their bloodstream to protect them from these toxins.

Different factors are involved in the development of TSS and using tampons is one of these. But we still don’t know exactly why tampon use is linked to the development of TSS. Even so, research shows that the risk of menstrual TSS related to tampons is associated with absorbency: the higher the absorbency rating of the tampon, the higher the risk of getting the illness, and the lower the absorbency, the lower the risk. This is why you should always use the lowest absorbency rating possible to suit your needs, depending on your menstrual flow.

There is no evidence to show that the material used today to make tampons increases or leads to the production of the toxins that cause TSS. Neither have tampons been found to be carriers of the bacteria Staphylococcus aureus or to lead to their growth in the vagina.

No, this is not true. All tampons that are currently available on the market, including 100% cotton tampons, carry a low risk of TSS. The most up-to-date scientific information says that tampons made from rayon and cotton carry a similar risk of TSS. Whatever tampon you use, you should know how to recognise the signs and symptoms of TSS. If you notice these symptoms when using a tampon, take it out and contact your doctor.

It’s very important for women to know that TSS can occur with any product that’s inserted into the vagina, such as menstrual cups, tampons, contraceptive diaphragms and caps. If you use any of these products, the important thing is to be aware of the signs and symptoms of TSS, and that you should take the product out and seek medical attention if you experience TSS symptoms.

Symptoms and TSS facts

Symptoms of Toxic Shock Syndrome can feel a lot like the flu. If you experience any symptoms of TSS from tampons, and start feeling sick, remove your tampon ASAP and make sure you get to a doctor and tell them you think you might have TSS.

The main signs that can warn you of a possible case of TSS are:

• A sudden high temperature (usually 39Cº or higher)
• Confusion
• Convulsions
• Vomiting
• Diarrhoea
• Dizziness
• Low blood pressure
• Liver and kidney failure
• Irritated skin similar to sunburn
• Muscle pain
• Sore throat
• Fainting or feeling that you’re going to faint when you stand up
• In the advanced stages of the illness, your skin can peel (this happens 1-2 weeks after the skin irritation, and especially on the palms of the hands and soles of the feet)

Any of these symptoms can mean that you’re suffering from TSS. You may not have all of the symptoms, but there tends to be more than one. Menstrual TSS can occur at any time during your period or soon afterwards.

As TSS is a rare illness, there isn’t much information on the possible long-term consequences after recovery. When the illness is diagnosed and treated correctly, most people make a full recovery. As with other serious illnesses, there can be changes in the skin, hair and nails, but these will soon return to normal. A small number of people experience muscle weakness and psychological problems, such as finding it hard to concentrate, memory loss and mood swings. Fertility and the ability to get pregnant in female sufferers does not seem to be affected by the illness, but you should always let your doctor know if you have suffered from TSS so that you can be monitored properly.

Unfortunately, yes. Women, men and children can all get TSS. Children and young people are much more likely to get it than older people, as the existence of antibodies to protect you against the toxins partly depends on your age.

Around half of the cases detected have resulted from infections caused by a burn, an insect bite or surgery. The other half have been found in menstruating women, which is known as menstrual TSS and is associated with using tampons.

Another important thing to know about Toxic Shock Syndrome is that it is not contagious.

Nope. You can’t catch Toxic Shock Syndrome from anyone else.

Unfortunately, yes. Even if you’ve had TSS before, this doesn’t mean that you can’t get it again. TSS can reappear, and in fact one of the main reasons for it is the sufferer’s inability to produce enough antibodies. If a woman has had TSS before, they should see their doctor before using tampons again.

Treatements and prevention

After an early diagnosis, toxic shock syndrome treatment can be given successfully with rehydration, antibiotics and other suitable medication, depending on the symptoms.

If TSS is diagnosed in time and the appropriate treatment is given, there is a high probability of successful recovery. In fact, there are not many cases where the illness has had fatal consequences.

Most strains of the bacteria Staphylococcus aureus don’t produce toxins that can cause TSS, and only certain strains of these bacteria produce them. Also, the presence of a strain of the bacteria that generates these toxins, although necessary for TSS to develop, is not enough on its own. In fact, many studies show that although colonisation of these bacteria is very common, cases of TSS are actually very unusual. So what does the development of TSS depend on? Mainly, on whether or not the person has enough antibodies to fight against these toxins. Most women, although not all of them, have enough antibodies to protect them against these toxins.

If you have any of these symptoms and are using a tampon, you should take it out immediately and use a pad. Contact your doctor and let them know that you’ve been using tampons and that you’re worried that you might have TSS. It’s important to rule it out as soon as possible or, if necessary, to undergo toxic shock syndrome treatment as early as possible.

You can lower the risk of getting menstrual TSS by getting into some good habits when using tampons:

Change your tampon regularly, every 4-8 hours. Never leave a tampon in for longer than 8 hours. Always use the lowest absorbency rating you can, depending on your menstrual flow.Always make sure that you take the tampon out before putting in a new one. Make sure that you take out your last tampon at the end of your period. Tampons are only designed to absorb your menstrual flow. Don’t use a tampon as a protective method before your period or to absorb any vaginal discharge other than your period. It’s a good idea to use pads instead of tampons at least once a day during your period, ideally at night. If you prefer to use tampons overnight, you should make sure that you put a new one in just before you go to bed and take it out as soon as you get up. Never use a tampon overnight if you sleep for more than 8 hours.

Tampon manufacturers provide information on TSS and how to use tampons properly in the instruction leaflet that comes with their products. This information is updated regularly, so it’s important to read the leaflet carefully and to keep it for future reference.

When you use tampons, it’s important to choose the lowest absorbency rating to suit your menstrual flow. As the amount of flow varies throughout your period, it’s highly likely that you’ll need different absorbency ratings for different days of your period.

Choosing a tampon with the right absorbency rating comes with practice, but as a guide, if you need to change your tampon more often than every 4 hours, you should try one with a higher absorbency rating. On the other hand, if when you take the tampon out, it feels uncomfortable to remove or some of the fibre is still white, this means that you need a tampon with a lower absorbency rating.

Remember: don’t leave a tampon in for more than 8 hours.

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