Toxic shock syndrome (TSS) is commonly associated with tampon use in women. Toxic shock syndrome symptoms include fever and sunburn-like rash needing treatment.

Toxic Shock Syndrome – Frequently Asked Questions

Introduction

Toxic shock syndrome (TSS) is a combination of symptoms that affects numerous bodily systems. Some bacterial infections cause the release of toxins into circulation, which are then distributed to the body&#39;s organs and lead to serious disease and impairment. Approximately, 70% of women who tested positive for TSS in Canada, the United States, and a majority of Western Europe have been observed to use tampons during menstruation<a href="#accordion">[1]</a>.&nbsp;

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TSS was explained in 1978 for the first time when occurrences of illness fitting the TSS case definition (e.g., appearance of fever, low blood pressure, rash, skin peeling, and multiorgan system involvement) had begun to emerge in large numbers<a href="#accordion">[3][5]</a>. By 1980-81, it was considered in the United States.&nbsp;

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Dr. Schlievert, who was the first person to identify TSS toxin-1, the primary cause of TSS, stressed that tampons had a direct connection to TSS. While it&rsquo;s not the only reason, it was considered a major risk factor since those young women, who were otherwise healthy individuals, had one thing in common &ndash; they were using super-absorbent tampons<a href="#accordion">[4][8]</a>.&nbsp; 
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Understanding FAQs About Toxic Shock Syndrome

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<h5>Is Toxic Shock Syndrome Rare? 
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Yes, TSS is a rare multisystem disease characterized by a wide range of symptoms. While little research has been done in this regard, results indicate that it influences approximately 3 women of reproductive age in every 100,000 in the United States annually<a href="#accordion">[6]</a>. 
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<h5>Which Bacteria is Responsible for Toxic Shock Syndrome? 
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Staphylococcus aureus (S. aureus) is a common bacterium that triggers TSS. It generally lives on the skin of about 20% of healthy individuals&nbsp;and in the nose (30%), groin, armpit, or vagina without causing harm<a href="#accordion">[7][15]</a>. In rare occurrences, specific strains of these bacteria form toxins that trigger TSS. 
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<h5>When does Toxic Shock Syndrome occur? 
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<a name="_heading=h.1fob9te"></a>TSS develops after a skin cut or burn, a recent surgery, or using contraceptive sponges, diaphragms, superabsorbent tampons, or menstrual cups. In most cases, TSS symptoms appear as early as 12 hours following a surgery<a href="#accordion">[8]</a>. 
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<h5>Do Seasons Influence the Incidence of Toxic Shock Syndrome? 
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Yes, they do. The number of cases is higher particularly in the winter and spring season<a href="#accordion">[9]</a>. 
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<h5>Why do Tampons cause Toxic Shock Syndrome? 
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Tampons induce TSS because they become a breeding ground for bacteria, especially if they are not changed frequently enough. Moreover, tampons can adhere to the walls of the vagina, particularly when blood flow is low, causing small scrapes when removed. It&rsquo;s easy for the bacteria to enter the uterus through the cervix.

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It&rsquo;s recommended to remove the tampons after approximately 4-6 hours (or earlier in case of heavy bleeding) to reduce the risk of TSS<a href="#accordion">[9]</a>. On the other hand, this does not imply that females will automatically acquire TSS if they leave a tampon in the vagina for more than 4 hours. 
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<h5>Will using Organic Tampons Lower the Risk of Developing TSS?</h5>

No. The risk of developing TSS is the same whether the woman uses organic or non-organic tampons. The only difference that can elevate the risk of TSS is the tampons&#39; absorbency. A tampon with a higher absorbency can increase the risk of TSS, whereas a tampon with a lower absorbance has a lowered risk of TSS. That is why, whether organic or conventional, it&rsquo;s best to always use the lowest permeability tampon that will manage the flow. 
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<h5>Do Sanitary Pads have the Potential to Trigger Toxic Shock Syndrome? 
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Yes; the usage of pads makes the female vulnerable to TSS. It&#39;s uncommon, but it can occur. It&rsquo;s not the tampons themselves, but the environment, which is ideal for bacterial growth, that trigger the syndrome. 
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<h5>Is it Possible to get TSS from Wearing A Pad for an Extended Time? 
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The risk of getting TSS is linked to using tampons and other menstrual products, such as discs and menstrual cups, which are inserted into the vaginas for an extended time. With pads, this risk is low; however, not practicing proper period hygiene (e.g., wearing a pad for an extended time) can lead to other infections such as a yeast infection<a href="#accordion">[10]</a>. 
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<h5>Who can Acquire Toxic Shock Syndrome? 
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It&rsquo;s not just the women; anybody can acquire TSS and that includes men and children, too! While half of all reported occurrences of TSS are linked to females who use tampons, the other half are caused by localized infections, such as those induced by burns, boils, insect bites, or surgery.

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Evidence suggests that the risk of TSS is higher in children and teenagers because adults are more likely to have the required antibodies to safeguard them from the toxin that triggers TSS. 
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<h5>Is Toxic Shock Syndrome Transmissible? 
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TSS is an infectious disease that itself cannot be transmitted to other people. However, S. aureus, the bacteria that trigger infections and cause TSS, can be passed from one individual to the other through one-to-one contact<a href="#accordion">[5]</a>.

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<h5>Is Toxic Shock Syndrome Curable? 
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It is a serious condition, but most individuals get better completely if it&rsquo;s diagnosed and, consequently, treated early. 
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<h5>Is it Possible for Toxic Shock Syndrome to Resolve on its Own? 
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No; TSS will not resolve on its own. Immediate treatment is required to avoid possibly fatal outcomes.

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<h5>Is Toxic Shock Syndrome Capable of Causing Sepsis? 
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The release of toxins into the body by specific bacteria triggers TSS. Although group A streptococcus (strep) bacteria can cause TSS, S. aureus (staph) bacteria are more commonly responsible. They can cause sepsis and septic shock<a href="#accordion">[11]</a>. 
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<h5>Is there a Difference Between Septic Shock and Toxic Shock? 
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Bacterial infections can cause septic shock and TSS in children. An overpowering immune reaction to the infection triggers septic shock, whereas toxic shock results from bacterial exotoxins<a href="#accordion">[3][12]</a>. 
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<h5>Is Toxic Shock Syndrome Capable of Triggering Seizures? 
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TSS can indeed trigger seizures. Any individual, adult or child, who exhibits symptoms of TSS should seek immediate medical attention. The infection has the potential to spread speedily throughout the body.

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<h5>Is Toxic Shock Syndrome always Deadly? 
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<a name="_heading=h.3dy6vkm"></a>TSS is a possibly fatal condition that occurs suddenly. It does not always result in death, and most people are able to recover completely if they are diagnosed and treated early.

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<h5>Does Toxic Shock Syndrome have Long-Term Consequences?</h5>

 
Most patients recover completely, but since TSS is uncommon, there is less data about the long-term consequences. There have been reports of long-term muscle weakness, though, as well as psychological effects like trouble concentrating, memory loss, and emotional changes<a href="#accordion">[13]</a>. 
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<h5>Why does Toxic Shock Syndrome Necessitate Amputation? 
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The body becomes severely ill as a result of bacterial toxins which is why patients are advised amputations of toes, fingers, or even limbs<a href="#accordion">[5]</a>.

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<h5>Is it Possible to Acquire Toxic Shock Syndrome Multiple Times? 
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Sadly, yes<a href="#accordion">[14]</a>. Anyone who has previously experienced TSS due to tampons especially should talk to their medical professional before using tampons in future. Many specialists prohibit tampons if a patient has a history of TSS.&nbsp; 
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Conclusion

The disease known as toxic shock syndrome or TSS is severe. It is caused by toxins that release germs. Tampon use is frequently linked to TSS. However, it can also occur as a result of childbirth, burns, skin diseases, or surgical incisions. TSS's initial symptoms include a sudden, high temperature and a rash that resembles sunburn.

Key Points

<ul><li>A rare but potentially fatal condition known as toxic shock syndrome (TSS) is believed to be triggered by bacterial infection.</li><li>TSS is brought on by toxins that have been released by bacteria in the body.</li><li>TSS requires hospitalization and intravenous antibiotic therapy.</li></ul>

[1] Parsonnet J, Hansmann MA, Delaney ML, Modern PA, DuBois AM, Wieland-Alter W, et al. Prevalence of toxic shock syndrome toxin 1-producing Staphylococcus aureus and the presence of antibodies to this superantigen in menstruating women. J Clin Microbiol. 2005;43(9):4628–34.

[2] Nelson E, Jordan M. Seeking new markets for tampons, Procter \& Gamble tries “bonding sessions” and school slide shows to win sales in Mexico. Wall Str J. 2000;

[3] Poudel B, Zhang Q, Trongtorsak A, Pyakuryal B, Egoryan G, Sous M, et al. An overlooked cause of septic shock: Staphylococcal Toxic Shock Syndrome secondary to an axillary abscess. IDCases. 2021;23:e01039.

[4] Toxic shock syndrome (TSS). Toxic Shock Syndrome (TSS) | Johns Hopkins Medicine.

[5] Toxic shock syndrome. NORD (National Organization for Rare Disorders).

[6] Stanley CN UHAA. Prevalence and antibiotic susceptibility of Staphylococcus aureus and other staphylococcal infections in pregnant women attending antenatal clinic in a tertiary hospital in Port Harcourt, Nigeria. OMICS International.

[7] Node view. Toxic Shock Syndrome | HealthLink BC.

[8] What is toxic shock syndrome? Poison Control.

[9] Santos-Longhurst A. How often should you change your pad? Healthline.

[10] Toxic shock syndrome. Sepsis Alliance.

[11] Septic and toxic shock syndrome (TSS) - children's health. Children's Health – Making Life Better for Children in Texas.

[12] Toxic shock syndrome: Symptoms, causes, and diagnosis. Medical News Today.

[13] Toxic shock syndrome. Mayo Clinic.

[14] Bush LM. Staphylococcus aureus infections - infections. MSD Manual Consumer Version.

Neelam Asad

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