What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a rare but life-threatening condition caused by bacterial toxins.

It is often associated with tampon use in particular in young women, according to the NHS, but it can affect anyone including men or children.

Its prevalence is between 1 and 5 cases per 100,000 inhabitants; however, toxic shock syndrome has gained social relevance due to some serious cases that have transcended in social networks. 

For example, the case of the model Lauren Wasser, who suffered the amputation of both legs after a serious case of infection by this bacterium. Recently a new severe case has been reported which also required amputation of both feet and almost all the phalanges of the toes of Sandrine Graneau, 36 years old.

So the question is how can you recognise toxic shock syndrome, how can you prevent it, and how is it treated?

To answer the first question, we must remember that toxic shock syndrome is extremely rare; moreover, less than half of the cases are associated with intimate hygiene products. In the opinion of Dr. Miguel Ángel Herráiz, a specialist in gynaecology and obstetrics, there is no reason to fear using tampons, pads or menstrual cups.

Causes

Toxic shock syndrome is caused by the proliferation of Staphylococcus aureus, a bacterium that is naturally found in our body: on the skin or in mucous membranes such as the vagina. This means that not only women but also men and children can suffer from toxic shock syndrome.

Some environments can encourage the growth of these bacteria which can release a toxin inside the body, which leads to what we know as a toxic shock. Finally, in severe cases, this toxin can cause necrosis (tissue death), which leads to the need to amputate the damaged tissues, as occurred in the viral cases mentioned at the beginning of this article. In very severe cases, in addition to necrosis, it can produce multi-organ failure; and in extremely severe cases, even death.

Not all people who develop TOS will end up suffering necrosis (and thus the need for extreme medical procedures, such as amputation); in many cases, the immune system removes the toxin from the body. Only rarely does the toxin affect the tissue in such an aggressive manner.

What can cause toxic shock syndrome?

Any delicate event that can introduce this bacteria into the body: open wounds, surgical procedures, burns, childbirth, pharyngitis, during a varicella-zoster infection, and from bleeding absorption materials such as gauze, which also includes feminine hygiene products such as sanitary pads, tampons, and menstrual cups.

The latter represents 50 % of all cases of toxic shock.

However, this does not mean that if you use hygiene products during your menstruation that you are at risk of suffering TSS, as it only occurs on very rare occasions.

Moreover, even if a toxic shock syndrome occurs, it only becomes a serious case if it is not treated after the first signs of infection. What are these signs?

Symptoms

The symptoms of toxic shock may go unnoticed at first. They include high fever, dizziness, confusion, nausea, vomiting, diarrhoea, skin rash, decreased blood pressure, headache, and muscle aches.

The first thing a health care provider will do if she suspects toxic shock is to remove any foreign objects from inside the body (such as a tampon that has been inside the vagina for many hours). Therefore, it is important to change them often: a maximum of 4 to 8 hours) to avoid the proliferation of these bacteria.

Toxic shock is diagnosed by taking a blood culture of the specific bacteria that causes it, Staphylococcus aureus.

Treatment

Although unlikely, a toxic shock is serious because it acts quickly. Therefore, early diagnosis is essential to avoid further consequences.

If there are no complications, treatment consists of intravenous medication: specific antibiotics aimed at ending the infection. In addition, if other types of damage have occurred as a result of the shock, such as organ failure, treatment will also require specific drugs aimed at alleviating these consequences; for example, drugs to regulate blood pressure.

How can toxic shock syndrome be prevented?

The bacteria that cause it are naturally present in our bodies. Therefore, we cannot totally prevent a toxic shock syndrome; but we can reduce the chances (even more) of it happening to us. The way to prevent TSS is to maintain good hygiene of open wounds, bleeding and mucous membranes in the body. With regard to products aimed at menstruation, it is recommended not to wear the same tampon for more than 8 hours in a row and to adapt the level of absorption to each woman.

Dr. Miguel Ángel Herráiz states that, rather than causing it, "the abusive use of intimate hygiene products can aggravate an already existing case of toxic shock syndrome".

In short, if we frequently use products such as tampons and menstrual cups, we should not be afraid of toxic shock syndrome, as long as we respect the recommendations for use and listen to the health professionals when faced with any wound or surgical procedure we undergo.