TOXIC SHOCK SYNDROME

DEFINITION

Toxic shock syndrome (TSS) is an uncommon, but potentially serious, illness. It almost always occurs in women using super-absorbent tampons during menstruation, but researchers are still not entirely clear what the connection is between this kind of tampon and TSS.

DESCRIPTION

Toxic shock syndrome first came to public attention in the 1970s when thousands of young women began to go to emergency rooms with a common set of symptoms. Those symptoms included high fever, vomiting, peeling skin, low blood pressure, diarrhea, and a rash resembling sunburn. Most of these women had one thing in common: they were all menstruating. And the majority were using a new type of tampon called a super-absorbent tampon.

The epidemic reached its peak between 1980 to 1984. During that period, about fifteen thousand people a year were diagnosed with TSS. About 15 percent of those who got the disease died of it.

Doctors were not certain what the connection was between TSS and super-absorbent tampons, but it was obvious that some connection existed. Tampon manufacturers were encouraged to discontinue the product and when the manufacturers did, the number of TSS cases began to fall dramatically. Since 1998, only about 5,000 cases of TSS are diagnosed annually. The death rate has fallen to about 5 percent.

For many years, TSS has been thought of as a woman's disease because of the connection between TSS and tampons. And while TSS is largely a disease that affects menstruating women under the age of thirty, individuals of either sex, any age, and any race or ethnic group can get disease.

Streptococcal Toxic Shock Syndrome (STSS)

The form of toxic shock syndrome first seen in the 1970s is caused by a group of bacteria known as Staphylococcus aureus (pronounced STAFF-uhloh-kock-us AW-ree-us). In 1987 a new form of TSS was discovered that is caused by a different bacterium that belongs to the Streptococcus (pronounced strep-tuh-KOK-us) family.

CAUSES

The Staphylococcus bacterium that causes toxic shock syndrome is found in the nose and mouth and, less often, the vagina. The bacterium releases a toxin (poison) that can get into the bloodstream. The toxin can cause an infection that is potentially fatal.

Researchers are still not certain as to how tampons promote the growth of Staphylococcus bacteria. One theory is that the tampons trap oxygen, which bacteria need to survive. Oxygen normally is not present in the vagina in large amounts. Another theory is that tampons provide a warm, moist environment that encourages the growth of bacteria. Yet another theory places the blame for TSS on the material of which the tampons were made. This theory suggests that the material irritated the vaginal lining. Sores on the vagina may have made it easier for bacterial toxins to get into the bloodstream.

SYMPTOMS

Toxic shock syndrome begins suddenly with a fever of 102° F (38°C) or more. Other symptoms include vomiting, a watery diarrhea, headache, and a sunburn-like rash. Blood pressure may drop quickly. When this happens, the patient may become confused or go into shock. The kidneys may fail. Later, the skin on hands and feet may peel.

Streptococcal toxic shock syndrome (STSS) is characterized by fever, dizziness, breathing problems, and a weak, rapid pulse rate. The patient's blood pressure drops suddenly and dramatically.

DIAGNOSIS

Any woman who is wearing a tampon and experiences the described symptoms should remove the tampon at once seek medical advice.

Toxic shock syndrome first came to public attention in the 1970s when thousands of young women began to go to emergency rooms with a common set of symptoms. The majority of the women were using a new type of tampon called a super-absorbent tampon. (Reproduced by permission of

AP/Wide World Photos

)

In diagnosing TSS, the first step taken by a doctor may be ruling out other diseases. For example, an examination of the vagina may be needed to rule out sexually transmitted diseases (see sexually transmitted diseases entry). Blood tests or a vaginal smear can then determine the presence of the bacteria that cause either TSS or STSS. In a vaginal smear, a small amount of vaginal fluids is removed with a cotton swab. The fluid can then be examined under a microscope to determine if the bacteria that cause TSS and STSS are present.

TREATMENT

Both TSS and STSS are bacterial infections. They can both be treated, therefore, with antibiotics, drugs that fight bacteria. The vagina may also be cleaned to remove bacteria that cause the two diseases.

PROGNOSIS

When treated promptly and correctly, both TSS and STSS can be cured. TSS tends to recur within a period of about six months. The bacteria that cause the two diseases can also spread to other parts of the body and can produce complications in the liver, kidneys, lungs, and other organs. Untreated toxic shock syndrome can be fatal.

PREVENTION

Recommendations for preventing toxic shock syndrome usually involve instructions about the use of tampons. Experts recommend that women select products with the lowest possible absorbency. They also suggest that tampons be worn only during the day and that they be changed every four to six hours. Above all, women should wash their hands before inserting a tampon. Anyone who has had TSS even once should not use tampons again.

FOR MORE INFORMATION

Books

Barrett, Laurie. The Coming Plague. New York: Penguin Books, 1994.

Starr, Carolina V. Toxic Shock Syndrome. San Francisco, CA: Permeable Press, 1996.

Turkington Carol A. Infectious Disease A to Z. New York: Facts on File, 1998.