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Understanding Toxic Shock Syndrome -- the Basics

What Is Toxic Shock Syndrome?

Toxic shock syndrome is a sudden, potentially fatal condition. It's caused by the release of poisonous substances from an overgrowth of bacteria called Staphylococcus aureus, or staph, which is found in many women's bodies. Toxic shock syndrome affects menstruating women, especially those who use super-absorbent tampons. The body responds with a sharp drop in blood pressure that deprives organs of oxygen and can lead to death.

This disease made headlines in the late 1970s and early 1980s after the deaths of several young women who were using a brand of super-absorbent tampon that was later removed from the market. 

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Toxic shock syndrome is still mostly a disease of menstruating women who use tampons. But it has also been linked to the use of menstrual sponges, diaphragms, and cervical caps. A woman who has recently given birth also has a higher chance of getting toxic shock. And it can happen to men and women who have been exposed to staph bacteria while recovering from surgery, a burn, an open wound, or the use of a prosthetic device.

More than a third of all cases of toxic shock involve women under 19, and up to 30% of women who have had the disease will get it again. If you have ever had toxic shock, you must look out for the symptoms so you can get immediate medical care.

People who die from toxic shock are killed by the body's response to the poisons released by staph bacteria. Most people suffer hypotensive shock, in which the heart and lungs stop working.

If you are menstruating and have a high fever with vomiting, especially if you have been using tampons, you must get medical help right away. If you are using a tampon, menstrual sponge, diaphragm, or cervical cap when you become ill, remove it immediately, even before calling your doctor.

What Causes Toxic Shock Syndrome?

Toxic shock syndrome is caused by a poison produced by Staphylococcus aureus bacteria. This bacteria is one of several staph bacteria that cause skin infections in burn patients and hospital patients who have had surgery. 

Staph is normally -- and harmlessly -- present in the vagina. How staph causes toxic shock syndrome is not understood. But two conditions are necessary: First, the bacteria need an environment in which they can grow rapidly and release poisons. Then the poisons must get into the bloodstream.

A tampon saturated with blood is a supportive place for rapid growth of bacteria. It also seems to matter what the tampon is made of; polyester foam provides a better environment than either cotton or rayon fibers.

In cases from menstrual sponges, diaphragms, and cervical caps, either the device had been in the vagina for a long time -- more than 30 hours -- or, in the case of the sponge, pieces of the sponge remained in the vagina. 

The way in which bacterial poisons enter the bloodstream may also be related to tampon use. Sliding a tampon into place in the vagina may make microscopic tears in its walls, rupturing tiny blood vessels. A super-absorbent tampon -- especially if it's left in place too long, or if it is used when the menstrual flow is light -- can dry out the vagina, making such tearing even more likely.

Researchers investigating the causes of toxic shock syndrome have ruled out feminine deodorant sprays and douches, underwear, and other clothing. The condition is also unrelated to the woman's menstrual history, drug or alcohol use, cigarette smoking, swimming or bathing, or sexual activity.

WebMD Medical Reference

Reviewed by Nivin Todd, MD, FACOG on March 17, 2014

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