Media attention brought toxic shock syndrome to the forefront of women's health in 1980. Although the number of cases has decreased dramatically over the past 20 years, women still need to take precautions against this fast-moving infection.
Toxic shock syndrome (TSS) almost always strikes women, not men. While it can be extremely serious, it is also quite rare. Associated with tampon use since the 1970s, TSS is caused by a toxin released by Staphylococcus aureus ( S. aureus ), in the nose or on the skin by up to 1/3 of the population.
Although TSS can affect anyone, more than 90% of cases occur in women under the age of 40, and begin during a woman's menstrual period. The few other cases of TSS have been related to exposure to a Staphylococcus infection contracted during surgery or after suffering a burn or open wound. Although most people have naturally occurring antibodies that protect them from this toxin, some do not, and it is in these people that infection by S. aureus bacteria can lead to TSS.
In the late 1970s, tampons—especially the super-absorbent type—were linked to an increased susceptibility to TSS, especially in women under age 25. Although the exact relationship between tampon use and TSS is still not known, it is believed that tampons may cause very small cuts, lacerations, or ulcerations in the vaginal wall, which make it easier for bacteria to enter into the bloodstream.
Researchers believe that super absorbent tampons cause the greatest degree of risk because they can actually adhere to the vaginal wall and thus cause an even greater degree of damage to the vaginal surface when removed. And some studies have shown that tampons containing rayon fibers may actually increase the production of the toxin that causes TSS.
The US Centers for Disease Control and Prevention confirms that new cases of TSS have indeed declined since the mid-1980s. A number of factors could account for the observed decline, including:
However, at least 40% of menstrual TSS cases continue to affect women ages 13 to 19, an age group not as likely to be aware of the risk for TSS and for whom further education may be needed.
Over the last few decades, two changes have occurred in tampon use and composition that may also be related to the decline in the number of new cases. All-cotton tampons have been introduced and successfully marketed as an alternative product, and tampons marketed specifically for overnight use have also been introduced.
One of the important changes in new cases of TSS is the increasing proportion of nonmenstrual cases being reported after surgical procedures. These are often the result of a streptococcal rather than a staphlococcal infection. Factors contributing to this increase may be a growing number of outpatient procedures and the use of prosthetic devices, such as heart valves.
The symptoms of TSS, which almost always come on very suddenly and occur in women, usually strike during or following a menstrual period. These symptoms include:
While relatively rare, TSS can lead to serious complications, especially if left untreated. TSS can lead to shock , kidney and/or liver failure, paralysis, and miscarriage . In a very small number of cases, death can result from hypotensive shock. The body's reaction to the toxins can be overwhelming—blood pools near the digestive track, causing the heart and lungs to be deprived of blood and to stop working.
"Most of the symptoms caused by TSS can also be caused by other conditions or diseases, such as Rocky Mountain spotted fever and measles ," says Jacques Carter, MD, general internist and public health specialist at Boston's Beth Israel Deaconess Medical Center. "However, when a high fever and a number of the other symptoms associated with TSS suddenly strike during or soon after a woman's menstrual period, doctors will generally suspect TSS and begin treatment while simultaneously searching to see if another condition or disease is the underlying cause. In addition, doctors will, in many cases, order a lab culture of the vagina, which can often detect the presence of S. aureus ."
While the treatment for TSS is relatively simple, it must be implemented quickly. Therefore, it is critical that any woman who is suddenly struck with a high fever and one or more of the other symptoms associated with TSS during or soon after a menstrual period immediately remove her tampon (if still present), and then call her physician to seek medical attention.
Treatment includes:
In severe cases, the patient may be hospitalized to allow the doctor to more closely monitor and, if necessary, treat for the possible complications that might develop (ie, shock , kidney failure , or liver failure).
Like most medical conditions, the best treatment for TSS is prevention. To that end, all women should take the following preventative measures:
Finally, though TSS is not contagious, it can strike the same person more than once. If you've had TSS before, don't use tampons again without first getting approval from your doctor.
RESOURCES:
The American College of Obstetrics and Gynecology
http://www.acog.org/
US Food and Drug Administration
http://www.fda.gov/
CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca/index_e.html/
Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm/
References:
Toxic shock syndrome in the United States: surveillance update, 1979-1996. US Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/eid/vol5no6/hajjeh.htm . Published October 1999. Accessed June 17, 2009.
Last reviewed June 2009 by Ganson Purcell Jr., MD, FACOG, FACPE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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