Toxic Shock Syndrome (TSS)

An uncommon condition caused by infection with Staphylococcus bacteria, characterized by a distinctive skin rash resembling sunburn on the palms and soles of the feet. The condition, first recognized in the 1970s, is associated with the use of certain brands of highly absorbent tampons (now taken off the market). About 70 percent of cases occur in girls and women who were using tampons when symptoms begin. The U.S. Food and Drug Administration estimates that one out of every 100,000 menstruating girls and women develops toxic shock syndrome (TSS) each year.

About three percent of TSS cases are fatal. Since 1984 there have been 69 reports of death related to tampon use; all but three were caused by TSS. However, the risk of death from TSS is higher in cases not related to menstruation.

Symptoms
When related to menstruation, TSS symptoms may not begin until the first few days after a girl’s period and tend to appear quickly. In addition to the skin rash, symptoms include sudden high fever, vomiting and diarrhea, headache, muscular aches and pains, dizziness, and disorientation. Blood pressure may drop rapidly and shock may develop. The sunburn-like rash may not develop until the patient is very ill, or it may go completely unnoticed if it appears in a small area. The skin on palms and feet may flake and peel. Once a person has had TSS, she is more likely to get it again.

Death usually occurs as a result of a prolonged drop in blood pressure or lung problems.

Cause
The condition is caused by a toxin produced by Staphylococcus aureus. Scientists first described TSS as a distinct disease in 1978; two years later, reports of the problem increased among girls who had become ill during or just after menstruation. Studies showed that the use of the high absorbency tampons was associated with the problem, but the exact connection remains unclear.

While it is most common in connection with menstruating girls and women using tampons, TSS also occurs in newborns, children, and men, primarily as a result of infection after surgery.

Scientists believe that for TSS to develop, the staphylococcus bacteria must release one or more toxins into the bloodstream. While these bacteria normally live without causing problems in the nose, skin, and vagina, they can sometimes lead to serious infection after a deep wound, surgery, or during extended tampon use.

Treatment
Antibiotic drugs and intravenous infusion (to prevent shock), plus treatment for any complications as they occur. Recurrence is common; girls and women who have had toxic shock syndrome should not use tampons, cervical caps, diaphragms, or vaginal contraceptive sponges.

Prevention
The best way to prevent TSS is not to use any kind of tampon. Because the risk of TSS rises with increased tampon absorbency, it is a good idea to use products with the lowest absorbency and to change tampons very often.