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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Spanish version
Toxic Shock Syndrome
What is toxic shock syndrome?
Toxic shock syndrome (TSS) is a rare, life-threatening
infection that occurs when toxins (poisons) produced by a
certain type of bacteria enter the bloodstream. Women using
highly absorbent tampons during menstruation are most likely
to get this infection. However, it can also occur in men
and children. About 3% of cases are fatal.
How does it occur?
The names of the bacteria that cause TSS are Staphylococcus
aureus, Streptococcus pyogenes, and Clostridium sordelli.
These bacteria often live harmlessly in the nose, mouth, and
vagina. Rarely, these bacteria grow quickly and produce a
large amount of toxins, resulting in a serious infection.
Women between the ages of 15 and 30 have the highest risk of
TSS. About 70% of TSS cases have been related to the use of
certain brands of highly absorbent tampons. Although these
brands are no longer sold, many other brands still contain
highly absorbent fibers.
There are two theories about how tampons may help cause TSS:
- Tampons may keep bacteria blocked in the vagina, where
they may grow quickly and produce toxins.
- Tampons may cause very small cuts in the vagina. The
bacteria or their toxins may enter the bloodstream
through these cuts.
Some cases of TSS have been linked to the use of birth
control devices such as the cap, sponge, or diaphragm.
Others occurred because of skin wounds, surgery, or
infections elsewhere in the body.
What are the symptoms?
Toxic shock syndrome begins suddenly and develops quickly.
The symptoms include:
- fever of 102°F (40°C) or higher, usually with chills
- rash that looks sometimes like sunburn and sometimes like
red dots or patches
- headaches
- sore throat
- vomiting or diarrhea
- dizziness, lightheadedness, fainting, or near fainting
- cramping
- confusion.
In addition, TSS may cause a sudden drop in blood pressure.
This drop in blood pressure can lead to shock if it is not
treated promptly.
How is it diagnosed?
Your health care provider will discuss your symptoms with
you and do a physical exam. Your provider may get samples
of your blood and urine. He or she may also get samples
from your vagina, cervix, and throat to check for bacteria.
How is it treated?
Toxic shock syndrome is treated in the hospital with IV
antibiotics to fight the bacterial infection. You may be
given medication to lower your fever. You may also be given
IV fluids and medicine to raise your blood pressure.
How long will the effects last?
The effects usually last 1 to 3 weeks. However,
staphylococcus infections can recur. About one third of the
women who develop TSS during menstruation have it again
within 6 months. TSS may also recur after 6 months.
The kidneys, liver, lungs, and other organs can be affected
by TSS. The extent of these effects depends on how ill you
are.
How can I take care of myself?
Take all the antibiotics your provider prescribes for you.
Also, be sure to tell your provider if you are taking any
other medicine. Ask if there are any possible side effects
from the medicine that you need to know about.
Get emergency care if you develop symptoms of TSS again.
What can be done to help prevent toxic shock syndrome?
Women can help prevent TSS during menstrual periods by:
- not using tampons at all
- not using super-absorbent tampons
- wearing each tampon no longer than 4 hours, especially
the highly absorbent types
- when menstrual flow is heaviest, using sanitary pads
instead of tampons every other day
- using less absorbent tampons if the type of tampon you
have been using is irritating or hard to remove
- wearing sanitary pads during sleep to allow any
irritation from tampon use to heal.
Taking birth control pills can also lower the chance of
having TSS.
Men and women can help prevent TSS by:
- keeping skin cuts and scrapes clean
- seeing the health care provider if a wound shows signs of
skin infection, such as:
- redness
- swelling
- unusual drainage
- increasing pain
- red streaking from the wound.
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