What is Toxic Shock Syndrome (TSS)? Causes, symptoms and treatment

Toxic Shock Syndrome is a rare, life-threatening condition. It arises from a bacterial infection - most commonly from strains of Staphylococcus aureus bacteria, but can also be caused by Streptococcus bacteria. Women are more likely to develop Toxic Shock Syndrome during menstruation. What is TSS? What causes Toxic Shock Syndrome?

Table of content:

By Dr Melisa Holmes, OB-GYN & Founder of Girlology

When I talk about tampons in my gynaecology practice, I find some patients are terrified of Toxic Shock Syndrome (TSS), while others have never even heard of it. Toxic Shock Syndrome is serious, so it’s important to understand, but there’s no need to panic. Let’s get to the facts so you can know (and share) the truth!

Toxic Shock Syndrome meaning, also known as TSS, is a rare, but serious infection that is caused by a specific strain of Staphylococcus aureus bacteria. Interestingly, these bacteria are commonly found on the skin, in the nose, armpits, and vagina without causing any problems. However, under certain circumstances, especially when the body has not developed immunity to this strain of bacteria, it can grow out of control and release a toxin, which is like a poison. The toxin enters the blood stream and can rapidly cause a severe illness that affects the entire body (shock).

TSS symptoms not only affects women of childbearing age, but men, children and menopausal women can also be affected. It is important to remember that TSS is not an infectious disease. It is not transmitted from person to person.

The risk of developing TSS can be increased by:

• Use of tampons or menstrual cups- particularly if you leave them in for longer than recommended.
• Use of mechanical methods of contraception (vaginal sponges, IUDs, condoms).
• Condition after natural childbirth - during the postpartum period.
• Staphylococcus aureus infection.
• Operative wound.
• Low blood pressure.
• Skin conditions and injuries - surgical wounds, burns, frostbite.

Toxic Shock Syndrome (TSS) is caused by the common bacteria Staphylococcus aureus. The bacteria normally live harmlessly on the skin and in the nose, armpit, groin or vagina of one in every three people. In rare cases certain strains of these bacteria can produce toxins (poisons) that cause TSS.

Toxic Shock Syndrome is caused by bacteria – specifically Staphylococcus aureus – not tampons. In the 1980s, TSS became more well-known because it was associated with highly absorbent tampons (those highly absorbent tampons were quickly taken off the market). However, you don’t need a tampon to get TSS. You can get it while using pads or menstrual cups, or no period protection at all. Anyone can get TSS. Even men and children can get TSS, and only about half of TSS infections are related to menstruation. Some other ways people develop TSS include insect bites, skin infections, or surgery.

Fortunately, Toxic Shock Syndrome is rare. To put it into perspective, you are more likely to die from being struck by lightning than you are from Toxic Shock Syndrome.

Those who are most at risk are people whose immune system is not functioning properly and children, as their immune system is not fully developed.

There are also things you can do to reduce your risk of TSS (keep reading to learn more)

Signs of Toxic Shock Syndrome (TSS): you can feel a lot like the flu, and symptoms can vary from person to person, but most commonly, the Toxic Shock Syndrome symptoms are:

• High fever (over 102° F or 38.9° C)
• Body or joint aches
• Nausea and/or vomiting
• Diarrhoea
• Dizziness or fainting or confusion
• Sometimes there is a red rash
• Tachycardia (increased heart rate)
• Decrease in systolic pressure
• Tachypnoe (accelerated and shallow breathing
• Exfoliation of the epidermis - especially on the palms of the hands (inner) and the soles of the feet (occurs within 1-2 weeks after early symptoms of Toxic Shock Syndrome)
• Symptoms of mucositis: pharynx, nose, conjunctiva, vagina (itching, burning, local soreness)

If you are using a tampon and feel very ill with some of the symptoms above, it’s important to remove your tampon right away, get immediate medical attention, and tell the person you’re with or the healthcare provider you’re worried about Toxic Shock Syndrome.

Toxic Shock Syndrome is a poisoning of the body caused by bacterial toxins. To diagnose toxic shock, the doctor takes into account the symptoms. In addition, blood tests, a chest roentgen, an electrocardiogram and, in women, a gynaecological examination may be carried out.

Although TSS is serious, it’s very treatable – especially when treated early. One of the biggest mistakes people make about their health is ignoring symptoms and waiting too long to seek medical attention. Toxic Shock Syndrome treatment should be introduced rapidly. If you have any concern that you might have TSS while using a tampon, you should remove your tampon, get immediate medical attention, and tell the healthcare provider that you’re worried you might have TSS.

Toxic Shock Syndrome treatment requires hospital treatment. The patient must be admitted to hospital and antibiotic therapy is required to treat the underlying infection. Some patients have reduced saturation (oxygen saturation of the blood) and also require oxygen therapy. In addition, Toxic Shock Syndrome symptoms is also treated by:

• Blood pressure control,
• Fluid therapy,
• Dialysis therapy - if kidney function is impaired,
• Surgical procedures - if it is necessary to remove infected tissue.

TSS is rare, but you can reduce your risk even more by following a few recommendations:

• Always use the lowest absorbency tampon that will manage your flow. If it hurts to remove after a few hours, go down a size.
• Change your tampon regularly - as often as recommended on the pack, but no less frequently than every 4-8 hours). Check if you can sleep with your tampon.
• Always wash your hands thoroughly before and after tampon application.
• Never use more than one tampon at a time.
• Take care of your intimate hygiene.
• Know the symptoms of TSS mentioned above and get immediate medical attention if you are worried you may have it.
• The risk of tampon-related TSS can also be reduced by interrupting tampon use with pads from time to time.
• Treat wounds and burns as soon as possible, and if there are signs of infection such as swelling, redness or oozing of pus - go to the doctor as soon as possible.

Check the answers to the most frequently asked question about toxic shock syndrome.

Nope. What you use is a personal choice, but the risk of getting Toxic Shock Syndrome is the same for organic or non-organic tampons, and it’s also the same for cotton, rayon, or a blend of the two. The only difference in tampons that can increase the risk of TSS is the absorbency. A higher absorbency tampon can increase the risk of TSS and a lower absorbency can have a lower risk. That’s why you should always use the lowest absorbency tampon that will manage your flow – and it doesn’t matter if it’s organic or conventional.

Unfortunately, yes. If you’ve had tampon-related Toxic Shock Syndrome in the past, you should consult your doctor before using tampons. Most doctors recommend not using tampons if you’ve had TSS before.

There’s no exact answer to this, but there are recommendations. You should never wear a tampon more than eight hours for hygiene purposes. Most gynaecologists also recommend you change your tampon every 4-8 hours for vaginal health reasons. We know that the risk of TSS increases with absorbency, and there is no precise time limit supported by research. It’s always healthiest and safest to use the smallest tampon that will manage your flow and to change your tampon regularly.

I know that was a lot of information about Toxic Shock Syndrome to take on board, so here’s a quick review:

• Toxic Shock Syndrome is a rare but serious infection
• TSS is treatable, especially if it’s caught early
• You can reduce your risk of TSS
• Use the lowest absorbency tampon you can to manage your flow
• Break up your tampon usage with pads. Know the symptoms! If you’re using a tampon and you experience any flu-like symptoms, take your tampon out and seek immediate medical attention, letting the medical professional know you’re worried you might have TSS.

To find out more information about our full range of Tampax tampons, click here.