Toxic shock syndrome (TSS) is a rare but serious medical condition caused by a bacterial infection. It can be caused when the bacterium Staphylococcus aureus gets into the bloodstream and produces toxins. But this isn’t the only cause.
Although TSS has been linked to superabsorbent tampon use in menstruating people, this condition can affect males, children, and people of all ages.
TSS is an extremely rare condition. The average number of cases a year is about
Symptoms of TSS can vary from person to person. In most cases, symptoms appear suddenly. Common signs of this condition include:
- sudden fever
- low blood pressure (hypotension)
- muscle aches
- redness of eyes, mouth, and throat
- organ failure
- sore throat or problem swallowing
Many of the TSS symptoms are often associated with other ailments. Symptoms like fever, sore throat, or headache can easily be attributed to another medical condition, such as the flu.
That’s why it’s important to be aware of what TSS is and what can cause it. If you experience the above symptoms after using tampons or after a surgery or skin injury, contact your doctor immediately.
Infection usually occurs when bacteria enter your body through an opening in your skin, such as a cut, sore, or other wound.
While the bacteria Staphylococcus aureus can be one cause of TSS, it’s not the only one.
Another bacteria called Streptococcus pyogenes (GAS) can be a factor. This is sometimes referred to as streptococcal toxic shock syndrome or toxic shock-like syndrome (TSLS). This bacteria can enter the body through a skin injury or bacteria developing in the throat, and then spread through deep tissues and the bloodstream. Over time it may progress into TSS.
The symptoms and treatment for this syndrome are nearly identical to those of TSS. However, TSLS is not associated with tampon use.
Other strains of Streptococcus have been associated with toxic shock, though this is rare. In addition, TSS has also been known to occur with post-surgical infections, burns, cases of nasal packing after nosebleeds, and even dialysis catheters.
Experts aren’t sure why tampon use sometimes leads to the condition. Some believe that a tampon left in place for a long period of time attracts bacteria. Another possibility is that tampon fibers scratch the vagina, creating an opening for bacteria to enter your bloodstream.
Tampons have changed a lot over time, and it’s unclear if a specific type of tampon or tampon applicator can cause TSS. If you feel like one type of tampon seems to irritate (or scratch) the vagina, you may consider switching brands.
TSS has always been considered a rare disease, but cases have dropped significantly over recent decades.
Risk factors for this condition include a recent skin burn, skin infection, or surgery. Other risk factors may include:
- recent childbirth
- use of a diaphragm or vaginal sponge to prevent pregnancy
- an open skin wound
- use of superabsorbent tampons
- nasal packing
- compromised immune system
- recent flu diagnosis
Infants and the elderly are more at risk for developing a GAS infection. People who are at greater risk for a GAS infection are also more likely to develop TSLS. Your risk may be increased if you have:
- abused alcohol
- undergone surgery
Your doctor may make a diagnosis of TSS based on a physical examination and your symptoms. A diagnosis can be made through:
- a blood or urine test checking for bacteria
- a blood test to check liver and kidney function
- a CBC (complete blood count) testing for white blood cell count or a decrease in platelets
- taking swabs of cells from the cervix, vagina, and throat
- analyzing samples for bacteria that cause TSS
- a coagulation study to evaluate blood clotting ability
TSS is a medical emergency. Some people with the condition have to stay in the intensive care unit for several days so that medical staff can closely monitor them.
Your doctor will most likely give you intravenous (IV) hydration of water, electrolytes, and glucose (crystalloids). This is to help you fight the bacterial infection in your body and dehydration. This will help you manage TSS initially.
Next, your doctor will likely administer antibiotics that are appropriate for your specific case. Antibiotics for treatment of GAS infection or TSS are typically given for
Other possible treatments include:
- medication to stabilize blood pressure
- gamma globulin injections to suppress inflammation and boost your body’s immune system
- surgical debridement (removal of infected deep tissue)
Other treatment methods for TSS vary depending on the underlying cause. These can include:
- If a vaginal sponge or tampon triggered toxic shock, your doctor may need to remove this foreign object from your body.
- If an open or surgical wound caused TSS, the doctor will drain pus or blood from the wound to clear any infection.
TSS is a life-threatening medical condition. In some instances, TSS can affect major organs in the body. If left untreated, complications associated with this disease include:
- liver failure
- kidney failure
- heart failure
- coagulopathy, which presents with signs, such as bruising, easy or prolonged bleeding, pinpoint rash, blood in urine or stool, or bleeding from the gums
Signs of liver failure can include:
- yellowing of the skin and eyes (jaundice)
- upper abdominal pain
- difficulty concentrating
- dark urine
Signs of kidney failure may include:
- nausea and vomiting
- muscle cramps
- persistent itching
- chest pain
- shortness of breath
- high blood pressure
- sleep problems
- swelling in the feet and ankles
- problems urinating
Signs of heart failure may include:
- heart palpitations
- chest pain
- lack of appetite
- inability to concentrate
- foot and leg swelling
- shortness of breath
Signs of coagulopathy may include:
- irregular heartbeat
- chest pain
- fast and shallow breathing
- dilated pupils
Certain precautions can reduce your risk of developing toxic shock syndrome. These precautions include:
- changing your tampon
every 4 to 8 hours
- wearing a low-absorbency tampon or sanitary napkin during menstruation
- using a reusable silicone menstrual cup and cleaning your hands thoroughly when changing it
- wearing a sanitary napkin on light-flow days
- washing your hands frequently to remove any bacteria
- keeping cuts and surgical incisions clean and changing dressings often
Don’t wear tampons if you have a personal history of TSS. This condition can recur.
Toxic shock syndrome is a medical emergency that can cause death if untreated. Call an ambulance or go to the emergency room if you suspect that you have symptoms of TSS. Prompt treatment can fight infection and prevent major organ damage.