Toxic Shock Syndrome

________________________________________________________________________

KEY POINTS

• Toxic shock syndrome (TSS) is a rare but sometimes deadly infection that happens when toxins (poisons) made by bacteria get into the bloodstream. Women using highly absorbent tampons during their menstrual periods are most likely to get this infection.
• TSS is treated in the hospital with IV fluids and medicines including antibiotics.
• Ask your healthcare provider how long it will take to recover, if there are activities, and how to take care of yourself at home.

________________________________________________________________________

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a rare but sometimes deadly infection that happens when toxins (poisons) made by bacteria get into the bloodstream. These bacteria often live harmlessly in the nose, mouth, and vagina and on the skin. Rarely, these bacteria grow quickly and produce a large amount of toxins, resulting in a serious infection.

What is the cause?

Women using highly absorbent tampons during their menstrual periods are most likely to get this infection. However, older women, men, and children can also get it.

There are 2 theories about how tampons may help cause TSS:

• Tampons may keep bacteria blocked in the vagina, where they may grow quickly and produce toxins that are absorbed by the body.
• Tampons may cause irritation and 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. TSS can also develop from cuts or scratches on the skin, surgical wounds, problems after childbirth, or infections elsewhere in the body, such as a breast infection.

What are the symptoms?

TSS starts suddenly and worsens quickly. Because the infection is in your bloodstream, you can have symptoms in almost any area of your body. The symptoms may include:

• Pain or muscle aches
• Fever, usually with chills
• Nausea, vomiting, or diarrhea
• Areas of skin that are red, warm, and swollen. The skin may first look like it’s sunburned and then you may have red dots or patches of redness. Large patches of skin may peel off 1 to 2 weeks after the beginning of the illness, usually starting with the palms of your hands and soles of your feet.
• Headache, sore throat, cough, feeling tired
• Shortness of breath
• Confusion
• Seizures

TSS may cause a sudden drop in blood pressure. Symptoms of very low blood pressure may include dizziness, lightheadedness, and fainting. This drop in blood pressure can lead to shock if it is not treated promptly.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You may have tests of your blood and urine. Samples of fluid from your vagina, cervix, and throat may also be tested for bacteria.

How is it treated?

TSS is treated in the hospital. Anything that is in the vagina, such as a tampon, will be removed. You may be given:

• IV fluids and antibiotics to fight the bacterial infection
• Medicines to lower your fever, raise your blood pressure, and help your body fight infection

If TSS happened as a result of surgery, you may need more surgery.

How can I take care of myself?

Take all of the antibiotic medicine prescribed for you. Be sure to tell your healthcare 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.

Follow your healthcare provider's instructions. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent toxic shock syndrome?

If you are a woman, you can help prevent TSS during menstrual periods by not using tampons at all.

If you choose to use tampons:

• Change your tampon at least every 4 to 8 hours.
• Select the lowest absorbency tampon for your flow. After 4 to 8 hours of use, if there is still white fiber showing on the tampon, you can use a lower absorbency tampon.
• When your menstrual flow is heaviest, use sanitary pads instead of tampons every other day.
• Use a fresh tampon right before going to sleep, or use a sanitary pad if you plan to sleep more than 8 hours. Using a sanitary pad during sleep can help irritation from tampons to heal.

If you use a diaphragm or contraceptive sponge for birth control, remove no more than 6 to 8 hours after you have sex.

Taking birth control pills is another way to lower the chance of having TSS.

You can also help prevent TSS by:

• Keeping skin cuts and scrapes clean
• Seeing your healthcare provider if you think a wound is infected