Toxic Shock Syndrome

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a rare, life-threatening infection that occurs when toxins (poisons) produced by a certain type of bacteria enter the bloodstream. Women using highly absorbent tampons during their menstrual periods are most likely to get this infection. However, it can also occur in older women, men and children. It can also develop from cuts or scratches on the skin or surgical wounds. About 3% of cases are fatal.

How does it occur?

The names of the bacteria that cause TSS are Staphylococcus aureus, Streptococcus pyogenes, and Clostridium sordelli. These bacteria often live harmlessly in the nose, mouth, and vagina and on the skin. Rarely, these bacteria grow quickly and produce a large amount of toxins, resulting in a serious infection.

Menstruating women have the highest risk of TSS. About 70% of TSS cases have been related to the use of highly absorbent tampons.

There are 2 theories about how tampons may help cause TSS:

• Tampons may keep bacteria blocked in the vagina, where they may grow quickly and produce toxins that are absorbed by the body.
• Tampons may cause very small cuts in the vagina. The bacteria or their toxins may enter the bloodstream through these cuts.

Some cases of TSS have been linked to the use of birth control devices such as the cap, sponge, or diaphragm. Others occurred because of skin wounds, surgery, postpartum complications, or infections elsewhere in the body, such as a breast infection (mastitis).

What are the symptoms?

Toxic shock syndrome begins suddenly and develops quickly. The symptoms may include:

• fever of 102°F (39°C) or higher, usually with chills
• rash that looks sometimes like sunburn and sometimes like red dots or patches
• redness of the palms of the hands or the eyes
• headaches
• sore throat
• cough
• vomiting or diarrhea
• dizziness, lightheadedness, fainting, or near fainting
• cramping
• severe tiredness
• swelling of the vaginal area
• swelling of the hands and feet
• confusion
• convulsions

In addition, TSS may cause a sudden drop in blood pressure. This drop in blood pressure can lead to shock if it is not treated promptly.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. You may have tests of your blood and urine. Samples from your vagina, cervix, and throat may also be tested for bacteria.

How is it treated?

First, anything that is in the vagina needs to be removed, such as a tampon. Toxic shock syndrome is treated in the hospital with IV antibiotics to fight the bacterial infection. You may need to be admitted to the intensive care unit at the hospital. You may be given medicine to lower your fever. You may also be given IV fluids with electrolytes (salt additives), medicine to raise your blood pressure, or other medicines, such as IV immune globulin (a medicine that helps the body fight infection). If TSS happened as a result of surgery, you may need more surgery.

How long will the effects last?

The effects usually last 1 to 3 weeks. However, staph infections can recur. About one third of the women who develop TSS during a menstrual period have it again within 6 months.

The kidneys, liver, lungs, and other organs can be affected by TSS. The extent of these effects depends on how ill you are. Usually these organs recover after treatment, and the symptoms go away. Some people will temporarily lose some or all of their hair and nails up to 2-3 months after TSS.

How can I take care of myself?

Take all the antibiotics your provider prescribes for you. Be sure to tell your provider if you are taking any other medicine. Ask if there are any possible side effects from the medicine that you need to know about.

Get emergency care if you develop symptoms of TSS again.

What can be done to help prevent toxic shock syndrome?

Women can help prevent TSS during menstrual periods by:

• Not using tampons at all.
• Alternate tampon use with pantiliner pads.
• Not using super-absorbent tampons.
• Wearing each tampon no longer than 4 hours, especially the highly absorbent types.
• When menstrual flow is heaviest, using sanitary pads instead of tampons every other day.
• Using less absorbent tampons if the type of tampon you have been using is irritating or hard to remove.
• Wearing sanitary pads during sleep to allow any irritation from tampon use to heal.
• Removing a diaphragm, cervical cap, or sponge as soon as possible after sex.

Taking birth control pills can also lower the chance of having TSS.

Men and women can help prevent TSS by:

• Keeping skin cuts and scrapes clean.
• Seeing the healthcare provider if a wound shows signs of skin infection, such as:
  • redness
  • swelling
  • unusual drainage
  • increasing pain
  • red streaking from the wound
  • seeing the healthcare provider if you have a fever of 100.5°F (38°C) or higher.