What is TSS?

TSS is Toxic Shock Syndrome which was discovered in XX century in some women who
used old models of tampons (first tampon experiences). News appeared in public news in
1980s. Since then manufacturers changed dramatically the tampon production and the
number of cases of TSS has dropped significantly. Other causes for toxic shock syndrome
include the use of contraceptive diaphragms and vaginal sponges (by women), as well as
wound infections.

You've probably heard of this disease before, and how it may be connected to tampon use.
TSS (Toxic Shock Syndrome) is an infection that is very rare, but potentially dangerous. TSS
occurs most frequently in young women who wear tampons. You will probably never get
TSS, but it's good to know what the symptoms are and how to avoid putting yourself at risk.

Tampons themselves do not cause TSS. TSS is caused by bacteria called Staphylococcus
aureus. If the tampon is left inside of vagina for too long, it creates the perfect environment
for different types of bacteria, including Staphylococcus aureus, to grow.

What causes TSS?

Toxin-producing strains of Staphylococcus aureus causing toxic shock syndrome was first
formally described in 1978. Prior to this time the syndrome was known as staphylococcal
scarlet fever. Both menstrual and non-menstrual forms of toxic shock syndrome are caused
by these toxins, which release massive amounts of cytokines (cell-mediator chemicals) that
produce fever, rash, low blood pressure, tissue injury and shock.

In the late 1980s a disease that showed similar signs and symptoms to toxic shock
syndrome but was caused by toxins released by toxin-producing strains of Streptococcus
pyogenes, was discovered. This disease although sometimes also referred to as toxic
shock syndrome is more correctly known as streptococcal toxic shock-like syndrome (STSS)
or toxic strep.

How do you get TSS?

Toxic shock syndrome starts from a localised staphylococcal infection which produces the
causative exotoxins. About 15-40% of healthy humans are carriers of Staphylococcus
aureus, that is, they have the bacteria on their skin without any signs of infection or disease
(colonisation). However, individuals whom have not developed antibodies against
Staphylococcus aureus may develop toxic shock syndrome. In addition, toxic shock
syndrome may occur as a complication of other localised or systemic infections such as
pneumonia, osteomyelitis, sinusitis, and skin wounds (surgical or burns), where
Staphylococcus aureus infections may develop. In these situations the patient has
increased susceptibility to developing toxic shock syndrome.

How to avoid TSS?

To avoid developing TSS, follow these guidelines when using tampons:

	Change your tampons at least every 4-8 hours or more often if necessary
	Choose the correct tampon absorbency
	Use smaller sized tampons when your flow is lighter
	TSS occurs more often when super-absorbent tampons are used. Don't use these unless your menstrual flow is particularly heavy
	Alternate between pad and tampon use. You might want to use pads at night, and tampons in the daytime
	Wash your hands before inserting or taking out your tampon
	Don't use tampons to absorb anything other than your menstrual flow. Only insert a tampon once menstrual blood is present.

If you experience the following symptoms while wearing a tampon, remove the tampon, and
contact your health care provider immediately!

TSS Symptoms include:

	Sudden high fever
	Low blood pressure
	A sunburn-like rash (widespread red flat rash)
	Shedding of skin, especially on palms and soles, 1-2 weeks after onset of illness
	Diarrhea
	Dizziness, fainting, or lightheadedness
	Vomiting
	Severe muscle pain
	Disorientation or confusion
	Bruising due to low blood platelet count
	Red eyes, mouth and vagina due to increased blood flow to these areas

Mentioned symptoms could seem similar to the ordinary flu. If they occur while you are
menstruating and wearing a tampon – it could be TSS signals!
It is strongly recommended to visit your doctor!

Women who have had toxic shock syndrome should avoid using tampons during
menstruation as re-infection may occur. The use of diaphragms and vaginal sponges may
also increase the risk of toxic shock syndrome.