What Is Toxic Shock Syndrome?

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Toxic shock syndrome (TSS) is a rare but life-threatening condition caused by an infection. It can affect anyone of any age but often occurs because of using tampons, after giving birth, or from an infected wound. It affects about 1 in 100,000 people and is more common in women.

TSS causes toxins to spread into your bloodstream which can cause severe organ damage or death.  Symptoms develop quickly and you need to receive urgent treatment. These symptoms can include a sudden high fever, vomiting, diarrhoea, a rash, and confusion. You should call your doctor, or emergency services, immediately if you have signs or symptoms of toxic shock syndrome. This is especially important if you have recently used tampons or if you have a skin or wound infection.


What Causes Toxic Shock Syndrome?

Toxic shock syndrome usually results from toxins produced by two kinds of bacteria, namely Staphylococcus aureus (staph) bacteria and group A streptococcus (strep) bacteria. Normally, these bacteria live on your skin or on your mucous membranes (like your throat or mouth) without causing any ill effects. However, under certain conditions, some strains of bacteria may start to grow rapidly and produce toxins. If these toxins enter your bloodstream, you can become critically ill within a short period.

Although often associated with tampon use, toxic shock syndrome is unrelated to menstruation in more than half the cases. Tampon use, however, does remain a significant cause of TSS. Tampons (especially super-absorbent varieties) that are left in the vagina for too long may encourage bacteria to grow. Also, tampons can stick to the vaginal walls during lighter flow and cause small tears when they are removed. Bacteria can then enter your bloodstream through these tiny cuts in your vagina.


Toxins that cause TSS can also make their way into your bloodstream in the following situations:

  • From a contraceptive diaphragm or cap
  • Using menstrual cups (produces the same problems as tampons)
  • After giving birth (vaginal birth or caesarean section)
  • After illnesses such as the flu (influenza) or chickenpox
  • After surgery
  • Skin wounds, surgical incisions, scrapes, burns or other areas of injured or infected skin
  • Your chances of getting TSS are higher if you have had it before.


What Are The Symptoms Of Toxic Shock Syndrome?

The symptoms of toxic shock syndrome happen suddenly and worsen quickly. TSS requires urgent medical treatment as delaying treatment can result in organ damage or even death. It is, therefore, essential to know the symptoms. These include:

  • A sudden high fever
  • Low blood pressure
  • Vomiting or diarrhoea
  • A raised skin rash resembling sunburn that feels like sandpaper, particularly on your palms and soles (skin can peel off).
  • Confusion - acting confused, slurred speech or not making sense
  • Muscle ache - severe pain in your arms or legs, or all over your body
  • Redness of your eyes, mouth and throat
  • Seizures
  • Dizziness, light-headedness or fainting
  • Headaches

How Is Toxic Shock Syndrome Diagnosed?

There are several ways in which healthcare providers can diagnose toxic shock syndrome. Blood or urine tests will be taken to determine what type of bacteria or virus is present so that the correct medication can be administered.

If you have been using tampons, your vagina may be examined. Tissue samples from your vagina, cervix, throat or wound may be analysed for the presence of Staphylococcus or Streptococcus bacteria. If your symptoms are severe or have progressed, your healthcare provider may order a CT scan, chest X-ray or spinal tap (lumbar puncture).


How Is Toxic Shock Treated?

If you have toxic shock syndrome you will need urgent hospital treatment. The infection will not go away by itself.

If you were using a tampon, diaphragm, or any other foreign body, it should be removed immediately. Usually, you will be treated with intravenous (through a vein) antibiotics straight away while doctors determine the source of the infection. You will be given intravenous fluids to treat shock, and low blood pressure and prevent organ damage while intravenous fluids will also be given to treat dehydration. You may also require oxygen, dialysis (in people who develop kidney failure) and blood products.

Once the source of infection is identified, you may require surgery to remove infected tissue from cuts and wounds. Although toxic shock syndrome is a life-threatening condition, most people recover if they are diagnosed and treated quickly.


Preventing Toxic Shock Syndrome

Anything that stays in your vagina for longer than the recommended time can increase your risk for toxic shock syndrome. Besides tampons, these products can include cervical caps, sponges or diaphragms, or menstrual cups. To avoid getting TSS from these products you should only use them as instructed.

You should change your tampons regularly (at least every four hours) and avoid using super-absorbent tampons. You should use a tampon with the lowest absorbency required for your flow. Switching from tampons to pads every second day, at night or when your menstrual flow is heaviest may also help reduce your risk. You should never use tampons when you are not menstruating.

It is essential to wash your hands thoroughly when treating wounds. You should keep any cuts or burns clean, and look out for signs of infection, such as a rash, swelling or pain.

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