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toxic shock syndrome

Alternative Names

Toxic shock syndrome is a rare, potentially life-threatening disorder. It occurs when toxins made by certain types of bacteria are released into the bloodstream.

What is going on in the body?
Toxic shock syndrome (TSS) was first described in children in 1978. Experts quickly realised it happened more often among women who used super absorbent tampons during their periods. Despite the wide use of tampons in Australia, TSS is a rare illness with approximately 38 cases identified between 1981 and 1994 in Australia.

TSS is triggered by toxins made by a bacteria named Staphylococcus aureus. The toxins cause a high fever and may damage the kidneys, liver, and heart. Experts theorise that tampons may promote TSS by:
  • blocking bacteria within the vagina, where a moist, humid environment may let them grow to produce high levels of toxins
  • causing very small cuts in the vagina during insertion that allow bacteria and their toxins to enter the bloodstream
About 70% of TSS cases have been related to certain brands of highly absorbent tampons that are no longer made.

What are the signs and symptoms of the disease?
TSS usually starts suddenly and develops quickly. The symptoms include:
  • a fever 38 degrees Celsius or higher.
  • a rash anywhere on the body that looks like a sunburn. Usually it appears on the soles of the feet and palms of the hand, which may later peel.
  • headaches.
  • sore throat.
  • vomiting.
  • diarrhoea.
  • pelvic cramps.
  • confusion and disorientation.
  • dizziness, lightheadedness, or fainting.
  • very low blood pressure, causing shock and collapse.
What are the causes and risks of the disease?
Certain factors increase a woman's chances of getting TSS. They include:
  • wearing the same tampon for longer than 8 hours
  • leaving a diaphragm or cervical cap in the vagina for more than 36 hours
  • having recently had a baby
  • having recently had surgery
  • having a soft tissue abscess or pocket of pus
  • being between the ages of 12 and 30
Roughly 30% of women who develop TSS get it again. It is most likely to recur during the first 3 periods a woman has after treatment. The second bout may be more or less severe than the initial one. Recurrences are less common if a woman gets treatment to eliminate Staphylococcus bacteria during the initial infection.

What can be done to prevent the disease?
A woman can avoid TSS by:
  • not using tampons at all.
  • avoiding super absorbent products or using them for only 1 to 2 days of each period, being sure to change them frequently.
  • not using tampons for more than 6-8 hours. Changes in the design of tampons have occurred because of concern over toxic shock syndrome. Changing tampons frequently should nearly eliminate the risk of tampon-related toxic shock syndrome.
  • alternating tampons with pads every other day during the heaviest flow.
  • using pads while sleeping.
To avoid a recurrence, a woman should not use tampons again until cultures of the cervix, vagina and nasal airways taken at 2 different times over the course of more than 1 month show no signs of the Staphylococcus bacteria.

How is the disease diagnosed?
A doctor can diagnose TSS by getting a detailed history of the development of symptoms. These tests are also used to detect bacteria: Sometimes a spinal tap to culture the cerebrospinal fluid is done.

What are the long-term effects of the disease?
The effects of TSS usually last 1 to 3 weeks. TSS may recur in 30% of women within the first 6 months after treatment. If severe shock has occurred and led to kidney, liver, lung, or heart damage, long-term consequences may require treatment or cause permanent disability.

The 3 major causes of death related to severe TSS are: What are the risks to others?
If used tampons are disposed of properly, there are generally no risks to others.

What are the treatments for the disease?
A successful outcome depends on aggressive therapy. A severe TSS infection may require:
  • fluids and medications through the vein to maintain blood pressure
  • electrolyte or salt replacement
  • blood transfusions
  • antibiotics given through the vein
  • use of a respirator if the lungs are damaged
  • corticosteroids
What are the side effects of the treatments?
Allergic reactions to antibiotics may occur. However, these drugs may be needed to kill the bacteria and prevent serious complications. Blood transfusions can result in allergic reactions or infection.

What happens after treatment for the disease?
A woman should:
  • not use tampons for at least 6 to 8 weeks after treatment
  • avoid sexual intercourse for 3 to 4 weeks after being hospitalised to prevent any other vaginal or pelvic infections
How is the disease monitored?
After a woman has had TSS, she should stop using tampons and seek medical care right away if she notices any symptoms of a recurrence during her periods.

Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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