The Toxic Shock Syndrome
Information Service (TSSIS)
TSS is very rare
From a UK population of around 60 million there are about 40 cases reported each year, half of which are associated with women using tampons. In extreme cases it may prove fatal and sadly out of the small number of people who fall ill each year, 2-3 die from TSS. [Source: UK Public Health Laboratory Service 1985-1995]
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.
Men, women and children can get TSS
About half of the reported cases result from localised infections, for example following burns, boils, insect bites or following surgery. The other half of the reported cases are associated with women using tampons.
The risk of developing TSS can be increased by:
- Using tampons – particularly if you leave them in for longer than recommended or you use “super-absorbent” tampons
- Using female barrier contraceptives, such as a contraceptive diaphragm or contraceptive cap
- A break in your skin, such as a cut, burn, boil, insect bite or surgical wound
- Using nasal packing to treat a nosebleed
- Having a Staphylococcal infection or Streptococcal infection, such as a throat infection, impetigo or cellulitis
TSS isn’t spread from person to person
You don’t develop immunity to it once you’ve had it, so you can get it more than once.
With early diagnosis TSS can be successfully treated
Quick, effective treatment is vital so it’s therefore important to recognise the symptoms of TSS.
Some of the symptoms of TSS are much like severe ‘flu’ and usually include some or all of the following:
- High temperature (fever) of 39C (102.2F) or above
- Sunburn-like rash
- Fainting or feeling faint
- Muscle aches
- Breathing difficulties
Sometimes you may also have a wound on your skin where the bacteria got into your body, but this isn’t always the case and it may not look infected.
Consult your doctor at once if you, or anyone you know, has some of these symptoms and suspect TSS.
If a tampon is being worn it should be removed and the doctor should be told. Do not worry about being alarmist – it is important to rule out the possibility of having TSS and if necessary, your doctor will then be able to begin treatment early.
If you have TSS, you’ll need to be admitted to hospital and may need to be treated in an intensive care unit.
Treatment may involve:
- Antibiotics to treat the infection
- In some cases, pooled immunoglobulin (purified antibodies taken out of donated blood from many people) may also be given to fight the infection
- Oxygen to help with breathing
- Fluids to help prevent dehydration and organ damage
- Medication to help control blood pressure
- Dialysis if the kidneys stop functioning
- In severe cases, surgery to remove any dead tissue – rarely, it may be necessary to amputate the affected area
With early diagnosis TSS can be treated with antibiotics to kill the Staphylococcus aureus bacteria, and other medicines which help counteract the symptoms. Most people will start to feel better within a few days, but it may be several weeks before they’re well enough to leave hospital.
TSS & Tampon Use
It is estimated that approximately half the cases of TSS are linked to use of tampons.
The causal link to tampons and menstruation is not known, but users of any type of tampon irrespective of its composition, for example viscose/rayon, cotton, organic cotton or a blend, should be equally aware of the signs and symptoms of TSS. TSS cases have also been recorded with other vaginal devices such as contraceptive coils, diaphragms and menstrual cups.
Research in the 1980’s suggested that for cases which occurred in women using tampons, tampon absorbency was a factor so for this reason, it is recommended that:
- Tampons with the lowest absorbency suitable for the period flow are used
- A sanitary towel or panty liner is used from time to time during the menstrual period
Information about TSS is contained in the tampon manufacturers’ instruction leaflet. This information is often updated, so remember to read the leaflet regularly.
When using tampons, it is also important to remember to:
- Wash hands before and after inserting a tampon
- Change tampons regularly, as often as directed on the pack
- Never insert more than one tampon at a time
- When using at night, insert a fresh tampon before going to bed and remove it on waking
- Remove a tampon at the end of a period
Anyone who suspects they, or someone they know, is suffering from the symptoms of TSS should immediately seek medical attention. If using a tampon, remove it immediately and inform the doctor that you are menstruating and have been using tampons. TSS is treated easily in the early stages but can rapidly become very serious if left untreated.
The following measures can help reduce your risk of TSS:
- Treat wounds and burns quickly and get medical advice if you develop signs of an infection, such as swelling, redness and increasing pain
- Always use a tampon with the lowest absorbency suitable for your menstrual flow
- Alternate tampons with a sanitary towel or panty liners during your period
- Wash your hands before and after inserting a tampon
- Change tampons regularly – as often as directed on the pack (usually at least every four to eight hours)
- Never insert more than one tampon at a time
- When using a tampon at night, insert a fresh tampon before going to bed and remove it on waking
- Remove a tampon at the end of your period
- When using female barrier contraception, follow the manufacturer’s instructions about how long you can leave it in
- It’s a good idea to avoid using tampons or female barrier contraception if you’ve had TSS before.
Unlike many diseases, people do not develop immunity to TSS once they have had it; therefore, it has occasionally been known to recur.
If you have had TSS you need to remain alert to the signs and symptoms in the future, particularly as a result of localised infections following wounds, burns, surgical procedures, etc.
It is always as well to advise your medical team ahead of any surgical procedure that you have had TSS in the past. If you are female then it is wise to avoid tampons, and any other internal (vaginally worn) menstrual or contraceptive devices. Anyone wishing to continue to use such products should consult their doctor.
As TSS is so rare, there is little information available about long-term problems after recovering from the illness. When diagnosed and treated promptly, most people make a full recovery. As with any serious illness reversible skin, hair and nail changes can occur, but these usually return to normal fairly soon after the illness. A few people experience sustained muscle weakness and psychological problems such as difficulty concentrating, memory loss or emotional changes.
Future fertility and pregnancy outcomes in women who have had TSS do not appear to be affected, but you should always tell your obstetrician or doctor that you have previously had TSS so that you can be closely monitored after the delivery, when TSS has been known to recur.