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The toxic truth

Case of TSS turns attention back to tampons


Model Lauren Wasser says she lost her leg to toxic shock syndrome (TSS) in 2012, claiming the disease was caused by using tampons. After a long recovery, she recently told a number of news outlets she wants to raise women’s awareness about the dangers of TSS, and she’s also suing the tampon manufacturer.

The link between toxic shock syndrome and tampons is not new. In 1980, the Centers for Disease Control and Prevention issued a report on “a newly recognized illness” that was affecting women during or shortly after their periods. The culprits were superabsorbent tampons. Once the connection was determined, manufacturers scrambled to recall those products and agreed to educate the public on the risk of prolonged use of tampons as required by the Food and Drug Administration.

 So what is toxic shock syndrome?

“It’s a syndrome caused by the Staphylococcus bacteria,” said Dr. Richard Thompson of Novant Health OB/GYN in Bolivia, North Carolina. “It can be due to a superabsorbent tampon that has been used for too long allowing for the bacteria to seed, which creates an infection that leads to septic shock.”

TSS is a serious bacterial infection that can kill if left untreated. It is marked by high fever, low blood pressure and rash, and it can shut down organs.

“The infection can affect the pelvic area, but may also spread beyond there causing multisystem organ failure and even affect extremities accounting for amputation of limbs,” Thompson said.

Less than half of today’s cases of toxic shock syndrome are due to tampons, according to the National Institutes of Health (NIH). It is also seen in cases of skin infection, burns and following surgery and affects all genders and ages.

Despite its rarity, TSS is very dangerous. Some of its symptoms, such as a high fever and sore throat, are so common that they can be easy to dismiss until the condition worsens.

“Shock is a very serious thing,” Thompson said. “The symptoms will initially appear flu-like, but patients will deteriorate fairly quickly.”

Other symptoms include

  • Confusion.
  • Diarrhea.
  • Headaches.
  • Muscle aches.
  • Nausea.
  • Organ failure.
  • Seizures.
  • Redness of the eyes, mouth or throat.
  • A red rash resulting in skin peeling on the palms of the hands and soles of the feet.

The FDA has dispelled Internet rumors that tampons contain asbestos that cause TSS. However, it has known that manufacturers sometimes use rayon in tampons, though studies show that tampons containing the fibers are no more likely to cause TSS than cotton tampons with a similar absorbency.

To avoid toxic shock syndrome, doctors say not to use extra-absorbent tampons. Instead, read the box insert to determine the lowest effective absorption. In his practice, Thompson advises his patients not to use tampons for longer than 6 to 8 hours and to practice good hygiene. Other measures include:

  • Alternate using tampons with sanitary napkins.
  • Change a tampon every 4 to 6 hours.
  • Never use a tampon overnight

TSS can be identified in a patient through cultures. Since TSS can come from multiple sources, Thompson said doctors have to take a thorough history from the patient to piece the puzzle together.

To treat shock, patients will receive antibiotics and massive amounts of IV fluids at the hospital, Thompson said. Medicine to elevate blood pressure may be prescribed and dialysis may be needed for severe kidney problems. The NIH says that in some cases, patients will need monitoring in a hospital intensive care unit.

The bottom line: If you think you are developing an infection during your period, Thompson said, you should seek medical assistance.





Published: 7/21/2015