Toxic Shock Syndrome
|What Is Toxic Shock Syndrome?
This is a rare but severe disease that affects many of the systems of the body. It is caused by the bacteria Staphylococcus aureus which is often present in the vagina and other parts of the body, but usually causes no harm. Although Toxic Shock Syndrome (TSS) can occur in both women and men of any age, most cases are still associated with menstruating women who use tampons. This fact came to light in the 1980s after a significant number of healthy young women suddenly developed TSS, some even dying from it. When the small epidemic was reported to the CDC (Centers for Disease Control), the numbers started to decline. This may partly be because the public became more aware of the symptoms and sought earlier treatment, but it was probably more to do with precaution steps taken by tampon manufacturers. The original brand of tampon associated with TSS (‘Rely tampons’ by Procter and Gamble) was removed from the market and since then certain materials which were added to tampons to increase absorbency are no longer used. Nevertheless TSS still occurs in 1-2 out of every 100,000 menstruating women, and half of those cases are attributed to tampon use. TSS can also occur in those with skin infections, burns and people recovering from surgery.
• High fever (over 38.9 °C /102.02 °F).
Some of the early symptoms of TSS can be confused with flu, but it can quickly develop into life-threatening complications. Blood pressure can suddenly drop and result in serious shock and sometimes unconsciousness (hypotension). Liver and kidney failure can also occur.
There is no single test that will diagnose TSS. A diagnosis is usually given based on the presence of typical symptoms, primarily fever, rash and low blood pressure (hypotension). Any woman displaying signs of TSS and who has a tampon inserted should remove it instantly and contact their doctor. The doctor will probably examine the vagina to look for signs of inflammation suggesting a reaction. Other STD tests may be carried out, including those for chlamydia and gonorrhea which can produce very similar symptoms to TSS.
Any 'foreign' materials inserted in the body such as tampons or contraceptives should be removed instantly. The vagina will be cleansed with Betadine, an antiseptic solution to reduce colonization of the bacteria which is producing the toxin. If the bacteria entered the bloodstream through a surgical wound, the wound will be drained. TSS is then treated with antibiotics; these may be administered orally or through IV. If an IV is used, fluids to combat dehydration will also be given. In severe cases where kidney damage has occurred, dialysis will be necessary.
TSS is a fatal disease causing death in 5 percent of cases. The majority fortunately usually recover within 2 to 3 weeks. However, unlike many diseases, people who experience TSS do not develop immunity which means a recurrence is an ongoing danger. If you undergo surgery in the future, always advise your medical team that you had TSS in the past. It is also best to avoid use of tampons and other internally worn contraceptives. Fortunately as TSS is so rare, most primary care physicians will never see a case in their medical careers. Future fertility does not appear to be affected in women who suffer the disease, but it is important to tell your ob/gyn that you previously had TSS. Any delivery will need to be monitored closely as TSS can recur during delivery and childbirth.
The risk of TSS can be reduced by using the lowest possible absorbency tampons, or alternating tampons with sanitary napkins (towels). Since menstrual blood varies in volume, this may mean using 2 or 3 different absorbencies during a period. Fortunately the CDC has now mandated standardized absorbency ratings on all tampon boxes, so choosing the correct one is much easier. One way to know if the absorbency of a tampon is too high is to pull it out after 4 hours. If it slides out easily, the absorbency is correct. If there are still white areas and it is difficult to remove, then the absorbency is probably too high.
If you do use tampons, remember to:
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