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Toxic Shock Syndrome

Definition :
Toxic shock syndrome is a rare, life-threatening bacterial infection that has been most often associated with the use of superabsorbent tampons and occasionally with the use of contraceptive sponges.

In 1980, an outbreak of toxic shock syndrome occurred that mostly involved young women who had been using a particular brand of superabsorbent tampons. The cause of the outbreak seemed to be toxins produced by Staphylococcus aureus (staph) bacteria. Toxic shock syndrome can also result from toxins produced by group A streptococcus (strep) bacteria.

While the infection often occurs in menstruating women, it can also affect men, children and postmenopausal women. Other risk factors for toxic shock syndrome include skin wounds and surgery.

Signs and symptoms of toxic shock syndrome develop suddenly, and the disease can be fatal. You can take steps to reduce your risk of toxic shock syndrome.

Causes :
Researchers don't know exactly how tampons may cause toxic shock syndrome. Some believe that when superabsorbent tampons are left in place for a long time, the tampons become a breeding ground for bacteria. Others have suggested that the superabsorbent fibers in the tampons can scratch the surface of the vagina, making it possible for bacteria or their toxins to enter the bloodstream.

The brand of tampons associated with the original toxic shock syndrome epidemic in the 1980s was voluntarily taken off the market by the manufacturer. After that, the number of cases of toxic shock syndrome declined dramatically.

It's not just young, menstruating women who can develop toxic shock syndrome. About half the current cases occur in nonmenstruating people, including older women, men and children. Toxic shock syndrome has occurred in women who had been wearing a diaphragm or a contraceptive sponge. It's possible for anyone to develop toxic shock syndrome in the course of a staph or strep infection. The syndrome may occur in association with skin wounds or surgery.

When to seek medical advice :
Call your doctor immediately if you experience the signs or symptoms of toxic shock syndrome. This is especially important if you're menstruating or have just finished menstruating and have been using tampons or if you have a skin or wound infection. Tell your doctor what your symptoms are and how long you've had them.

You may need to provide blood and urine samples to test for the presence of a staph infection. Samples from your vagina, cervix and throat may be taken for laboratory analysis by using cotton swabs.

Symptoms :
The signs and symptoms of toxic shock syndrome may include :

  • A sudden high fever
  • Low blood pressure (hypotension)
  • Vomiting or diarrhea
  • A rash resembling a sunburn, particularly on your palms and soles — which, after a week or so, generally leads to peeling of the skin on your hands and feet
  • Confusion
  • Muscle aches
  • Redness of your eyes, mouth and throat
  • Seizures
  • Headaches

If you develop toxic shock syndrome, you'll likely be hospitalized and need antibiotics. Doctors will try to determine the source of the infection. Along with antibiotics, you'll receive supportive care to treat the signs and symptoms of toxic shock syndrome. If your blood pressure begins to drop (hypotension), you'll need medication to stabilize it and fluids to treat dehydration. The toxins produced by the staph or strep bacteria and accompanying hypotension may result in kidney failure. If your kidneys fail, you may need dialysis.

You can reduce your chances of getting toxic shock syndrome by changing your tampon frequently, at least every four to eight hours. Consider using the lowest absorbency tampon you can and try to alternate using tampons and sanitary napkins whenever possible.

Toxic shock syndrome can recur. People who've had it once can get it again. If you've had toxic shock syndrome or a prior serious staph or strep infection, don't use tampons at all.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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