Toxic shock syndrome (TSS) is often a cause of concern by medical experts. Usually accompanied by severe symptoms, TSS has often been attributed to hygiene-related issues and bacterial growth due to the incorrect use of tampons and menstrual cups Nonetheless, despite the perception of a significant risk, the actual likelihood is quite minimal.
What is Toxic Shock Syndrome?
According to Dr Dhwani Prashant Mehta, Obstetrician and Gynecologist, Toxic Shock Syndrome is a rare but serious medical condition caused by the release of toxic substances. She explains, ‘Usually toxins produced by certain strains of bacteria which are known to be notorious, release certain chemical mediators into the bloodstream that becomes detrimental. These toxins can lead to a systemic inflammatory response and lead to sepsis (a condition that happens when the body's immune system has an extreme response to an infection), the notorious bacteria and interleukins released in large amounts affect multiple organs and systems within the body.
‘This rare medical condition can affect both men and women of all ages. While it gained notoriety in the 1980s due to its association with tampon use, it can occur for various reasons, and its symptoms can be severe.’ she adds
She sheds light on how it can affect anyone who encounters specific bacteria that produce harmful toxins triggering a shock response in the body, and mentions that individuals can come into contact with these bacteria via open wounds, surgical procedures, and the use of tampons, childbirth, and different forms of infections. However, it's important to note that tampon use is responsible for only a small portion of cases.
Causes of Toxic Shock Syndrome (TSS)
‘While Staphylococcus aureus bacteria can indeed contribute to TSS, it's essential to recognise that it is not the exclusive culprit. Another bacterium known as Streptococcus Pyogenes can also play a role. This condition is occasionally referred to as streptococcal toxic shock syndrome or toxic shock-like syndrome (TSLS). The bacteria can enter the body through skin injuries or even originate from bacterial growth in the throat, anterior nasal nares (the external portion of the nose), subsequently spreading through deep tissues and the bloodstream, potentially evolving into full-fledged TSS.’, adds Dr. Dhwani.
The symptoms and treatment for TSLS closely mirror those of TSS, but it's vital to note that TSLS is unrelated to tampon usage.
Dr. Dhwani highlights how in a natural vaginal environment, Staphylococcus aureus is typically present without causing harm. The precise mechanism by which these toxins induce toxic shock syndrome remains unknown. However, two key conditions must be met: firstly, the bacteria require an environment conducive to rapid growth and toxin release, and secondly, these toxins must find their way into the bloodstream.
Tampons, particularly when saturated with menstrual blood, provide an ideal environment for the rapid growth of bacteria. The composition of the tampon material can also influence this process, with polyester foam proving to be more favourable for bacterial growth than either cotton or rayon fibres.
In some instances linked to menstrual sponges, diaphragms, and cervical caps, these devices had been left in the vagina for prolonged periods, often exceeding 30 hours. In the case of sponges, remnants of the sponge material remained in the vaginal cavity.
The manner in which bacterial toxins enter the bloodstream may also be associated with tampon use. The insertion of a tampon can potentially cause microscopic tears in the vaginal walls, leading to the rupture of tiny blood vessels. Prolonged use of highly absorbent tampons, even when menstrual flow is light, can result in vaginal dryness, further increasing the likelihood of such tears, adds Drs. Dhwani while talking about inadequate hygiene practices with tampons leading to this scenario.
It's important to note that researchers investigating the causes of toxic shock syndrome have ruled out factors such as feminine deodorant sprays, douches, underwear, clothing, menstrual history, drug or alcohol use, cigarette smoking, swimming or bathing, and sexual activity as triggers for the condition.
Symptoms of Toxic Shock Syndrome
TSS can manifest with a wide range of symptoms, which can vary in severity. Common symptoms include:
- Sudden High Fever: A sudden, high fever is one of the hallmark symptoms of TSS. It often appears abruptly and may spike quickly.
- Hypotension (Low Blood Pressure): TSS can lead to a drop in blood pressure, which can result in dizziness, lightheadedness, and even fainting.
- Rash: A sunburn-like rash that can be widespread and may involve peeling of the skin is a characteristic sign of TSS. It often starts on the palms and soles and can spread to other areas of the body.
- Confusion or Altered Mental State: Patients with TSS may experience confusion, disorientation, or changes in consciousness.
- Muscle Aches: Severe muscle pain and weakness can occur in TSS, making movement difficult.
- Headache: Intense headaches are another common symptom associated with TSS.
- Nausea and Vomiting: Many TSS patients experience nausea and vomiting.
- Diarrhea: Diarrhea may also be present in some cases.
- Sore Throat: A sore throat can be a symptom if TSS is caused by Streptococcus bacteria.
- Organ Dysfunction: As the condition progresses, TSS can lead to organ dysfunction, including kidney, liver, and heart failure, which can be life-threatening. There may be decreased urine output
Seeking Medical Attention is Crucial
Dr Dhwani believes that recognising the symptoms and seeking prompt medical attention is crucial to improve the chances of a positive outcome. Additionally, practising good hygiene, using tampons and other products as directed, and promptly addressing wounds or infections can help reduce the risk of TSS. While TSS is rare, awareness and early intervention are essential to ensure the best possible outcome for those affected by this condition.
'Using a menstrual cup is often promoted as a "No Pads Period" solution, and it is also hailed for its eco-friendly benefits, reducing waste and carbon emissions. However, it's crucial to emphasise that proper usage and education are paramount.’
She advises ‘Before considering a menstrual cup, always consult with your healthcare provider, especially if you have gynecological conditions like uterine fibroids, adenomyosis, or endometriosis. Certain red flags should prompt you to seek immediate medical attention, such as unusual vaginal discharge, vaginal pain or soreness, burning during urination or intercourse, and foul odours from the vagina.'
If you experience a high fever, dizziness, vomiting, or a rash resembling sunburn while using a menstrual cup, it is imperative to seek immediate medical care. Engaging in intercourse with a tampon in place is not advisable. Ensure that you use menstrual cups safely and responsibly to safeguard your health and well-being.’