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Risk factors for toxic shock syndrome

Recently, toxic shock syndrome made headlines as it was blamed for a Canadian teenager’s death. An autopsy found that bacteria in her tampon likely triggered toxic shock syndrome (TSS), which is a complication of a bacterial infection.

What is toxic shock syndrome? 

“Toxic shock syndrome is pretty uncommon, but also likely underreported,” says Lauren Powell, M.D., a family medicine physician at Piedmont. “The incidence of toxic shock syndrome related to tampon use has significantly decreased over the years.”

If you’re a woman and use tampons, you’ve probably read about toxic shock syndrome on your tampon box. Toxic shock syndrome was attributed to super high-absorbency tampons in the 1980s when tampons were made out of carboxymethylcellulose and polyester foam.

Experts believe this combination allowed Staphylococcus bacteria to grow, leading to a Staph infection and then toxic shock syndrome. This complication prevents blood from circulating in the body, causing the body to go into “shock.”

Since the 1980s, tampon manufacturers have altered their products to make them much safer – they’re now made from cotton or rayon. Today, TSS occurs in only about one to three in 100,000 menstruating women.

Who is at risk for toxic shock syndrome?

“Tampon use continues to be a risk factor, particularly if you use high-absorbency tampons, keep a tampon in for a longer period of time and use tampons continuously for several days during your menstrual cycle,” says Dr. Powell.

While tampons are much safer these days, it’s still important to change your tampon at least every eight hours and use the lowest absorbency possible. Using superabsorbent tampons, diaphragms or contraceptive sponges can also raise a woman’s risk.

While TSS typically affects women who are menstruating, it can also affect children, men and post-menopausal women who:

  • Are recovering from surgery.

  • Have a viral infection.

  • Have a wound on their skin.

Symptoms of toxic shock syndrome

“Symptoms of toxic shock syndrome develop rapidly, usually within two to three days of the menstrual cycle,” says Dr. Powell. “These symptoms can range, but include low blood pressure, skin manifestation, watery diarrhea and neurological symptoms as the syndrome progresses to include the failure of multiple organs.”

Early symptoms to watch for include:

  • Sudden onset of a fever of 102 degrees or more

  • Bloodshot eyes

  • Chills

  • Confusion

  • Diarrhea

  • Fast pulse

  • Fatigue

  • Headache

  • Low blood pressure

  • Muscle aches

  • Peeling rash on the hands or feet

  • Vaginal discharge that is watery or bloody

  • Vomiting

The symptoms of toxic shock syndrome can be similar to other conditions. Always contact your doctor or visit urgent care if you have a high fever.

Dr. Powell practices at Piedmont Physicians Buckhead, located at 35 Collier Road Northwest, Suite 500, Atlanta, GA 30309. Schedule an appointment with Dr. Powell or one of our other primary care providers. Save time, book online.


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