Toxic Shock Syndrome: What women need to know


As the recent news story of a Michigan teen hospitalized for Toxic Shock Syndrome (TSS) after prolonged tampon use circulates the internet, many parents and teens are now left wondering if tampon usage is safe.

Here are some basic facts about TSS and what all females and parents should know about proper tampon usage.

What is Toxic Shock Syndrome? TSS is a rare illness caused by an exotoxin produced by Staph aureus, a bacteria that is found on the skin and mucous membranes of nearly 50 percent of healthy adults and children. If the exotoxin invades parts of the body where this common bacteria is not normally found, it can overgrow and signal the body’s immune system to launch a major inflammatory response, characterized by fever, rash, hypotension and multi-organ involvement. Fortunately, most individuals develop immunity to the exotoxin that causes the majority of cases by the age of 20, but this leaves the adolescent and young adult population at highest risk.

Who is at risk? Nearly half of TSS cases are related to menstruation, where tampon usage is a known risk factor. Tampon usage and menstruation are thought to facilitate TSS development due to the neutral PH of the vagina during menses and oxygen entering the vagina with tampon insertion. Another theory is that tampon insertion can create micro-tears in the vagina, allowing bacteria to enter the bloodstream.

Majority of these cases occur in females 13-19 years of age with the peak incidence occurring on the 4th day of menstruation. Those at higher risk for TSS are those who wear tampons with higher absorbencies (example: super plus), use tampons continuously for the whole cycle and those who leave tampons in for extended periods of time (over 8 hours).

The current incidence of menstrual-related TSS is estimated to be slightly less than 1 in 100,000 women. This has remained stable since the 1980s when the FDA began regulating tampon manufacturing by standardizing tampon absorbencies and banned the use of certain materials known to cause TSS.

What are the signs and symptoms? The earliest signs of TSS begin abruptly and can present with flu-like symptoms including fever, headache, vomiting, diarrhea and sore muscles. After several days the illness progresses to reveal a diffuse red skin rash that usually resembles a sun burn and can affect the body, hands, feet and also mucous membranes such as the mouth. Disease progression is also frequently accompanied by decreased blood pressure, mental status changes and can eventually affect multiple organ systems in the body. If TSS development is ever suspected, it is important that the individual is evaluated in the emergency room as early as possible.

How can it be prevented? The current FDA guidelines for decreasing the risk of contracting TSS include:

  • - Selecting the appropriate tampon absorbency for menstrual flow
  • - Follow package directions for proper tampon insertion
  • - Limit wear-time to no more than 8 hours per tampon
  • - Avoid wearing tampons overnight
  • - Consider alternating tampons with pads

Safe or not? The bottom line is, yes, tampons are safe to use as long as they are used properly. All teens should be familiar with the basics about TSS prevention before choosing to use tampons and should be properly educated on insertion techniques.

For more information regarding TSS and proper tampon usage, visit here.