Guest Author - Maria Hester, M.D.

Toxic Shock Syndrome (TSS) is typically caused by two common classes of bacteria, Staphylococcus aureua and Streptococcus. This article will focus on menstrual-related TSS which is typically caused by Staph aureus Everyone has heard of Staph infections. Staph infections range from something as benign as a simple, superficial skin infection to a life-threatening infection of the heart valves. Staph is an organism that can be found in many places. It actually colonizes the skin and mucous membranes of up to 50 percent of healthy adults and children, living silently on the skin, in the nose, rectum, and vagina.

Colonization does NOT mean the same as infection. If you were to swab your forearm with a wet Q-tip and then innoculate a petri dish and put it in an incubator, you would be alarmed by how many bacteria grow. These bacteria are common, and usually harmless bystanders that generally do no harm unless there is a breach in the integrity of the skin which allows them to creep into the body and set up an infection.

As mentioned, Staph can be found in many places where it seems to just live in harmony with its environment. However, sometimes it causes very serious illness. Once inside the body, Staph organisms can product enzymes that lead to inflammation, and sometimes even abscess formation. In addition, many strains of Staphylococcus produces toxins that can lead to conditions such as food poisoning and Toxic Shock Syndrome.

The term Toxic Shock Syndrome (TSS) is not new. It was first coined in 1978 to describe a syndrome first noted in children, but it became popular in 1980 after a series of menstrual-related cases of the syndrome, mainly in young women. This form of the illness was linked not only to menstrual cycles, but the use of highly absorbent tampons. Fortunately, the incidence of TSS has declined dramatically since it was first discovered.

While the withdrawal of highly absorbent tampons and polyacrylate rayon-containing products from the American market explains a significant amount of the decrease in menstrual-related cases of TSS, tampon use remains a risk factor. Specifically, women who develop TSS (compared to women who do not) typically continuously use tampons for more of their cycle days, keep tampons in longer, and use tampons with higher absorbencies.

However, it is important to note that the term Toxic Shock Syndrome is not unique to women. Nonmenstrual cases have been seen in many situations, such as after surgery, with bone infections, serious burns, and even respiratory infections, to name a few.

What are the signs of TSS?

In menstrual-related cases, the signs typicaly begin within 3 days of begininng the menstrual cycle. Symptoms may include the following:

Fever
Chills
Low blood pressure
Malaise
Headache
Abdominal pain
Sore throat
Vomiting
Diarrhea
Unusual skin changes, such as a diffuse red rash that can involve the palms and soles
Dizziness or passing out

However, keep in mind that all of these symptoms are nonspecific, meaning they can occur with many, many other conditions, so do not try to diagnose yourself should you develop them. See your doctor for full evaluation.

Shock due to TSS is typical of other types of shock. It can be rapidly fatal if not diagnosed and treated in time. A dangerously low blood pressure prevents adequate oxygen delivery to vital organs, which can result of failure of multiple vital organs, including the kidneys and liver. Treatment typically requires intensive care unit management.