In the realm of menstrual health and hygiene, Toxic Shock Syndrome (TSS) is a topic that women who have periods need to be familiar with. While TSS is a relatively rare condition, it’s critical to be informed about what it is, its symptoms and prevention, as it can be life threatening. This blog post is designed to educate you on TSS, helping you to know what TSS is, prevent it from happening, recognise it if it is happening to you or someone you know and when to call for help.

Understanding Toxic Shock Syndrome (TSS)

Toxic Shock Syndrome, or TSS, is a severe and potentially life-threatening condition that typically results from infections. While it is rare, the consequences can be fatal.

Developing TSS

In the UK, the incident rate per 100,000 women is 0.7 whereas in the US, the incident rate is between 0.8 to 3.4 every 100,000 women.

What Causes TSS?

TSS is usually triggered by a bacterial infection, primarily associated with the Staphylococcus aureus (staph) bacteria, although it can also be caused by Streptococcus pyogenes (strep). You can get an infection and then TSS, from using a tampon, menstrual cup or from a wound. The infection can produce harmful toxins, which, when released into the bloodstream, cause the symptoms of TSS.

 

Symptoms of Toxic Shock Syndrome

Common symptoms of TSS are:

  • High temperature
  • Flu like symptoms
  • A rash that feels like sunburn or like sandpaper
  • Muscle aches
  • Vomiting and diarrhoea
  • Peeling skin (including the hands and feet) or a rash
  • Feeling confused or dizzy or slurred speech
  • Feeling more tired than usual

 

Menstrual Products and Toxic Shock Syndrome

TSS is not exclusive to females only, it is possible for a male to develop TSS. However, it is important to understand the link between TSS and the use of certain menstrual products.

For TSS to occur, the Staphylococcus aureus (staph) bacteria and Streptococcus pyogenes (strep) bacterias need to over-grow and make large amounts of the TSS toxin, which then enters the bloodstream.

Tampons and Menstrual Cups increase the risk of TSS:

  • Tampons and menstrual cups that are designed to absorb or catch large amounts of blood, that are left in the vagina for a long time may encourage the TSS bacteria to grow
  • It is possible for a tampon to stick to the vaginal wall, especially when the blood flow is light. It is possible that when you removed a tampon on this environment, the tampon may damage the vaginal wall or a small piece may be left behind.

96% of TSS cases occur in menstruating females, related to menstrual product use. However, there have been cases where a female has developed TSS after giving birth.

 

Treatment of Toxic Shock Syndrome

If you are facing the possibility of Toxic Shock Syndrome, it is vital that you take immediate action and get medical help. You must also stop using tampons and menstrual cups right away.

Treatment for TSS includes:

  • Antibiotics to treat the bacterial infection
  • Hospitalisation to be given fluids for hydration, oxygen and to address low blood pressure
  • In rare cases, hospitalisation for more serious consequences such as kidney failure

 

Preventing TSS

The prevention of TSS primarily revolves around practising good menstrual hygiene. You must frequently change your period products. Tampons need to be changed every 4-6 hours and your menstrual cup needs to be emptied and cleaned every 6-8 hours. After each day, we recommend you clean your menstrual cup with antibacterial soap.

It is also important that we do not neglect our hands, as this is where bacteria can easily be spread. Always wash your hands with warm water and soap before and after inserting a tampon or menstrual cup to reduce the risk of transferring bacteria contamination.

If it is possible, use the lowest absorbency tampons for the current flow of your period, or use pads wherever possible. If you can, alternate between period products throughout your cycle to reduce the risk of developing the bacteria that causes TSS.

Lastly, be aware of the symptoms. If you notice you have any symptoms, remove your menstrual cup or tampon and change into a pad. If you have a couple of these symptoms, it is best to call 111 (or go online) and make sure you have someone with you who can help and observe if your condition changes. If you have more than a couple of these symptoms, we recommend you go to A&E or call 999. TSS can be fatal and the earlier you catch it, the better.

 

Before you go

Toxic Shock Syndrome (TSS) is a condition that, while rare, can pose a risk to your health and wellbeing. There is a connection between TSS and period products, specifically tampons and menstrual cups, but with frequent changing and by practising good menstrual hygiene, your risk of developing TSS is significantly lower. Now that you are aware of the symptoms of TSS too, we hope you will be able to detect TSS early and seek help from a medical professional before it has any impact.

Frequently Asked Questions

Read more about this topic

Can men get Toxic Shock Syndrome?
Men can contract Toxic Shock Syndrome, from contracting the bacteria in a wound
What’s the connection between tampons and Toxic Shock Syndrome?
Tampons are the leading cause of Toxic Shock Syndrome because they are inserted into the body, and if left too long may cause a bacterial infection which starts TSS.
What’s the role of staph and strep bacteria in Toxic Shock Syndrome?
Staph and Strep bacteria are the bacterial infections that cause Toxic Shock Syndrome to begin.
Can I swim or shower with a tampon in?
Yes. Just remember you take it out after 4-6 hours and wash your hands before and after.
How can I reduce my risk of Toxic Shock Syndrome?
You can reduce your risk of developing Toxic Shock Syndrome by ensuring that your hands are clean when changing your tampon or menstrual cup, and you are changing your period products within the right time. Alternatively you can switch to using pads or using period pants as much as possible.
What’s the relationship between menstrual cups and TSS?
Because menstrual cups are inserted into the vagina with our hands and left for hours at a time, this increases the risk of developing Toxic Shock Syndrome.
How can I identify Toxic Shock Syndrome symptoms?
Know the symptoms and recognise them if they pop up. Some common symptoms of Toxic Shock Syndrome are:
  • High temperature
  • Flu like symptoms
  • A rash that feels like sunburn or like sandpaper
  • Muscle aches
  • Vomiting and diarrhoea
  • Peeling skin (including the hands and feet) or a rash
  • Feeling confused or dizzy or slurred speech
  • Feeling more tired than usual
What should I do if I suspect I have Toxic Shock Syndrome?
Call 111 immediately to speak to a Doctor. We’d also recommend keeping someone with you in case you become very unwell. If you are experiencing multiple of these symptoms and are very unwell, call 999.
Can Toxic Shock Syndrome be fatal?
Though it is very uncommon, Toxic Shock Syndrome can be fatal if left untreated.
Should I stop using tampons or menstrual cups due to Toxic Shock Syndrome concerns?
Whilst we do not necessarily recommend stopping using tampons or menstrual cups, you may do so if you wish. You can still use tampons and menstrual cups, and never contract TSS.

References

Research further

References
Guerinot GT, Gitomer SD, Sanko SR. Postpartum patient with toxic shock syndrome. Obstet Gynecol. 1982 Jun;59(6 Suppl):43S-6S. PMID: 7088426.

https://www.nhs.uk/conditions/toxic-shock-syndrome/

Sharma H, Smith D, Turner CE, Game L, Pichon B, Hope R, Hill R, Kearns A, Sriskandan S. Clinical and Molecular Epidemiology of Staphylococcal Toxic Shock Syndrome in the United Kingdom. Emerg Infect Dis. 2018 Feb;24(2):258–66. doi: 10.3201/eid2402.170606. PMID: 29350159; PMCID: PMC5782905.

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