Toxic Shock Syndrome - Symptoms and Prevention

Symptoms of TSS and How to Prevent Toxic Shock Syndrome

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Toxic shock syndrome related to menses (mTSS) is a rare, but potentially fatal disease caused by one of two different types of bacteria, Staphylococcus aureus or Group A Streptococcus. These bacteria are normally found colonizing the vagina of most women.

Menstrual TSS affects approximately one or two out of 100,000 young women age 13-24 in the United States annually. Depending on the study the death rate from all types of TSS has been reported as high as 22%.However, dying from menstrual TSS is much less likely than dying from nonmenstrual TSS.

The mortality rate for menstrual TSS has decreased significantly from 5.5% in 1980 when it was first associated with menstruation.

Although TSS typically occurs in women under age 25, with the highest incidence in adolescent girls age 13-19 older women are not immune from developing this disease.

 Almost all reported cases of mTSS are related to tampon use. The exact mechanism of how TSS relates to tampon use in not exactly understood. Somehow the tampon, especially higher absorbency tampons, creates a favorable environment for these bacteria to produce toxins that cause the signs and symptoms of mTSS.

See also: Tampon Tips

While Caucasian women are significantly more likely to develop mTSS than women of other races, all women should know the symptoms of mTSS. This information is especially important for teenagers.Typically symptoms will occur within 3 days of the start of menses.

The most common signs and symptoms of TSS include:

  • Fever with or without chills
  • low blood pressure, which sometimes causes a feeling of dizziness or lightheadedness upon standing after sitting
  • skin changes that look like a sunburn, or redness of the tissue inside the mouth, eyes or vagina

Other less common symptoms of TSS may include vomiting, diarrhea, and muscle aches.

If you experience any of these symptoms during your period, seek medical care immediately. TSS is a rapidly progressing disease that can have devastating consequences if left untreated.

Is There Anything I Can Do to Prevent TSS?

Fortunately, there are some preventive steps you can take during your period to help prevent TSS.

The biggest step you can take to prevent TSS is to always change tampons every 4 to 8 hours. Using the proper tampon absorbency for your menstrual flow is also an important way to help prevent mTSS. This means using higher absorbency tampons only on your heaviest days of menstruation. On your lighter days, use tampons with lower absorbency.

Tip: You may be able to significantly lower your risk of getting TSS by alternating tampons and pads during your period; use tampons only during the day and pads at night, for example.

Other things you can do to lower your risk of developing TSS include making sure that you always follow the directions that come inside each box of tampons you buy. Some people may try to convince you that you can lower your risk of TSS by using certain types of tampons. This is simply not true. All types of tampons, whether made from cotton or rayon, put you at risk for TSS.

Tip: Only use tampons during menstruation. If you need extra protection at other times during the month, mini pads are your best option.

Updated by Andrea Chisholm MD

LeRiche,T MD et al. Toxic Shock Syndrome of a Probable Gynecologic Source in an Adolescent: A Case Report and Review of the Literature; Journal Pediatric Adolescent Gynecology 25 (2012)133-137

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