"Toxic shock syndrome is a situation in which a particular bacterium colonizes Staphylococcus aureus in one area and releases a toxin," Dr. Alyssa Dweck, a gynecologist in New York, told Buzzfeed News. S. aureus is typically the culprit, but another type of bacteria, Group A Streptococcus may also cause a toxic shock-like syndrome, or TSLS.
Anyway, TSS is rare. According to the US Centers for Disease Control and Prevention (CDC), since the 1980s, the US annual rate has been about 1 per 100,000 people.
Once the toxins are released by the bacteria, they can enter the bloodstream, triggering an immune response that damages other tissues and organs in the body. Symptoms include sudden high fever, low blood pressure and a sunburn-like rash, said Dweck. TSS can progress rapidly and cause kidney failure, shock, sepsis, or death within hours of onset of symptoms.
The bacteria must be present in or on the body for TSS to occur. S. aureus normally lives on the skin or in the respiratory tract, nose, vagina and rectum and about half of the population carries the bacteria without any symptoms or problems. Not all staph or streptococcal infections lead to TSS.
So why exactly is TSS associated with tampons and what does that mean for menstruating women?
Tampons alone do not cause TSS. They are not contaminated with bacteria or toxins – they come from our bodies. "The bacteria must be a natural resident of the vagina, and it's something about the highly absorbent tampons, or just something that lingers for a long time in that it tends to release these toxins," said Dweck. Younger women are at a higher risk.
After the rise in menstrual TSS in the 1980s, many manufacturers changed their ingredients, Dweck said. As a result, the number of cases of TSS has declined sharply, partly due to increased awareness of TSS and better education on the safe use of tampons.
Today, the Food and Drug Administration (FDA) regulates tampons as medical devices and manufacturers must meet stringent safety standards. Most tampons are made of a rayon-cotton blend and they are completely safe to use. Some brands offer 100% cotton or organic tampons, but these do not differ in terms of safety or absorbency. There is no evidence that tampons containing rayon increase the TSS risk. It's about how absorbent the tampon is and how long it stays in the vagina, said Dweck.
Besides, tampons are not the only culprit. "Anything that stays in the vagina for a long time can increase the risk of infection, including TSS," said Dweck. These include menstrual sponges or shells, diaphragms and condoms.
Taking a few simple precautions during your period can reduce the risk of developing TSS. "Use the least absorbent tampon for your flow, change it frequently during the day, and do not leave it for more than 8 hours – which is long enough to keep him sleeping during a whole night," said Dweck. If you bleed heavily, change your tampons more often.
In addition, you should only wear tampons when you are in your period. "Many women will come wearing tampons every single day of the month because they do not want a discharge – do not do that," said Dweck. The risk of TSS is still there if you have something in your vagina for a long time – including menstrual cups.
In recent years, menstrual cups have been touted as a safer alternative to tampons, but new evidence shows that they can also lead to TSS. So make sure you use your menstrual cup in the same way you would use tampons, which means you will empty them frequently and not keep them for long periods of time.
If TSS is detected early, it may be treated with antibiotics and infusions, said Dweck. So it's important to look for symptoms. "If you have a rash that looks like a sunburn or sudden high fever and low blood pressure with an associated menstruation and tampon, go to the emergency room or seek medical help immediately," said Dweck.