As a survivor of this disease, I have the need to educate women about a deadly disease that is rarely talked about. The disease I am talking about is Toxic Shock Syndrome. Up until I experienced this deadly disease myself, I did not near know enough about it. It occurred to me that I was not the only one who didn’t know the horrific details associated with this disease. What I thought about this disease was that it only happened if someone didn’t change their tampon often enough. However, I was very wrong. Please take the time to read this article below and share it with all the women in your life.
Toxic Shock Syndrome is an infectious disease that emerged in 1978. It is a potentially fatal condition that was coined as an emerging infectious disease in the first year that it was discovered by Dr. James K. Todd. Emerging infectious diseases are “diseases that are new, increasing in incidence, or showing a potential to increase in the near future” (Tortora, Funke, & Case, 2009, p. 416). Just like other infectious diseases, Toxic Shock Syndrome has an origin.
According to the article “Toxic Shock Syndrome History”, the disease started when “Proctor & Gamble introduced a super-absorbent tampon called Rely in August 1978… Rely tampons were marketed as highly absorptive, leak-proof tampons that could be left in place for the duration of a menstrual period” (Anonymous 2011). Incidences of TSS began to increase through January 1980 and 38 women died that year as reported by the Centers for Disease Control (CDC). Due to the increasing number of cases, experts tried to find reasoning and a solution for the numerous outbreaks of this disease.
It was soon discovered that tampon related TSS is caused by the Staphylococcus aureus bacterium that is acquired through the use of tampons in menstruating women. However, the disease is not caused solely by S. aureus but by an exotoxin secreted by the bacterium knows as TSST -1. The reason this disease is associated with tampon use is because “tampons provide an increased surface area for staphylococci to grow and adequate oxygen for the TSS toxin 1” (Reiser, 1988, p. 2762). A material in the tampon, synthetic fiber Viscose rayon, is used in tampons to increase absorbency. Dr. Philip Tierno, a microbiologist at New York University Langone Medical Center, stated that his “research clearly showed that any synthetic can amplify the toxin TSST-1”. Ultimately, tampons have the ideal physical and chemical conditions for toxin production.
The superantigenic properties of the toxin are responsible for the acute onset and severity of the disease (Eykyn, 1982, p. 1585). The TSST-1 toxin produced gets absorbed into the bloodstream and overwhelms the immune system causing the body to go into septic shock. The intense immune response causes multiple symptoms. Symptoms and characteristics of Toxic Shock Syndrome include the following: fever over 102°, diarrhea, vomiting, sunburn like rash, hypotension, tachycardia, fainting, lightheadedness, dizziness, confusion, conjunctivitis, and multiple organ failure. Once symptoms occur and a woman is using tampons, it is vital to get treatment right away because death can occur within days of first getting sick.
The first step of treatment is to immediately remove the tampon from the body. According to Dr. Jerry R. Balentine (2009), the tampon must be removed in order to “eliminate the source of the infection”. Intravenous fluids are used to raise and stabilize blood pressure. Strong antibiotics are needed to fight the infection and they are given through an IV to have an immediate effect. The different antibiotics that can be used include Vancomycin, penicillin, and cephalosporin. Oxygen support is also necessary for patients with TSS. A tracheotomy is sometimes necessary but oxygen masks also provide support; it depends on the severity of the infection when treated. Many liters of fluid are needed to raise and stabilize blood pressure and that can end up flooding the lungs and causing respiratory distress. A diuretic, which increases the rate of urination, is then used to excrete the excess fluid. Intravenous immunoglobulin has shown to be beneficial in treatment of acute infections like TSS. The immunoglobulin provides IgG antibodies from blood plasma that help neutralize toxins in the blood (Tortora et al, 2009, p. 480). Multiple organ failure can take place with Toxic Shock Syndrome if not treated quickly enough and permanent damage can occur. If permanent kidney damage occurs, dialysis treatment is needed. Organ failure can be avoided if immediate treatment is received at the onset of symptoms. Treatment of TSS requires emergency care in an intensive care unit. Minimum time spent in the hospital is about 7 days and can last up to weeks.
Unfortunately, due to the toxicity of toxic shock syndrome, there is a lot of stress on the body that causes after effects once released from the hospital. Recovery is a long process that requires patience. Muscle weakness is a very common problem after experiencing TSS. Patients are confined to a hospital bed for days or even weeks and therefore, muscle loss occurs. Walking is often difficult due to muscle loss in the legs. The sunburn like rash that is a symptom of toxic shock begins to peel for about 1-2 weeks after the initial infection. The immune system is also compromised following TSS because the body is very weak. Short term memory loss, low energy, and psychological distress are also after effects of the disease. The risk of getting toxic shock and experiencing the horrible disease is lowered if prevention methods are followed.
Prevention of toxic shock starts with education. Knowing the causes and symptoms of the disease is the first step in prevention. The smartest thing to do is to avoid wearing tampons altogether and find alternate methods. If no tampons are used, tampon-related toxic shock will never happen. If using tampons, be sure to use the lowest absorbency possible. According to the U.S. Food and Drug Administration (2009), “research conducted by the CDC suggested that use of some high absorbency tampons increased the risk of TSS in menstruating women”. It is a known fact that the higher absorbency the tampon, the greater the risk for toxic shock syndrome. Another precaution to take is changing tampons frequently every 4-6 hours. Washing hands before and after handling a tampon will help eliminate outside bacteria from entering the body. Although prevention methods are taken, TSS is still occurring and more often than most people think.
The CDC no longer keeps track of toxic shock cases. Dr. Philip Tierno points out that “TSS isn’t reportable to the CDC, but it gives out numbers on potential deaths”. An insert in a Tampax© Pearl tampon box states that “the incidence of TSS in the U.S. is estimated to be 1 to 17 cases per 100,000 menstruating girls and women per year with a 5% mortality rate”. The tampon inserts are not correct considering the fact that TSS cases are not reportable to the CDC. Dr. Patrick Schlievert, a toxic shock expert and professor at University of Minnesota, worked with the non-profit organization ‘You ARE Loved’ to determine the correct statistics. Through extensive research the actual statistics are known to be “1 in 700 women will get tampon related TSS in their lifetime” (Schlievert 2011) and 50% of TSS cases are fatal. It has become apparent that the tampon companies are trying to hide the truth about the occurrence of TSS cases in order to keep their products selling.
Toxic shock syndrome is a very serious and life-threatening disease. If not treated immediately, death will occur within days. The Staphylocccus aureus bacteria and the TSST – 1 toxin it produces attack the immune system and shut the body down. Treatment with antibiotics is needed to fight the infection and recovery is a difficult process. Education and awareness is a key factor in preventing this disease. Everyone, especially women, should be aware of the signs and symptoms and know the prevention methods to avoid experiencing this deadly disease.
Women need to know that if they are menstruating and experience any of the following symptoms listed to get help immediately.
Severe flu-like symptoms
Fever over 102°
Vomiting
Diarrhea
Rash
Fainting, lightheadedness, dizziness, confusion
Low blood pressure
Rapid heartbeat
Sore throat
Conjunctivitis
Please inform any of the women in your life about this disease, you could end up saving a life. Thank you.
Written By: Lauren Venosta
REFERENCES:
Balentine, J.R. (2009). What is the treatment for toxic shock syndrome? http://www.medicinenet.com/toxic_shock_syndrome/page3.htm#treatment
Eykyn, S. (1982). Toxic Shock Syndrome: some questions but answers remain. British Medical Journal, 284(6329), 1585-1586.
Hensel, K. (2011). Toxic Shock: why are women still dying? http://www.wishtv.com/dpp/news/local/marion_county/toxic-shock-i-team-8-investigation-attracts-attention
Reiser, R. , Denzin, L. , & Bergdoll, M. (1988). Effects of blood and different media on the production of toxic shock syndrome toxin 1 by staphylococcus aureus in the tampon sac method. J Clin Microbiol, 26(12), 2672-2674.
Schlievert, P. Dr. (2011). Incidence of TSS. http://you-are-loved.org/
Toxic Shock Syndrome History. Retrieved October 23, 2011, from http://www.soyouwanna.com/toxic-shock-syndrome-history-4296.html
U.S. Food and Drug Administration. (2009). Tampons and Asbestos, Dioxin, and Toxic Shock Syndrome. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PatientAlerts/ucm070003.htm
