Toxic Shock Syndrome: It’s Not Just About Tampons

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Photo: Dorling Kindersley/Getty Images

A Vice story published on Wednesday about a 27-year-old who had part of her right leg amputated three years ago after being hospitalized with toxic shock syndrome (TSS) has nearly every woman we know posting Facebook declarations that they're switching to the Diva Cup. The victim, Lauren Wasser, claims the illness was the result of using a tampon and she is suing Kotex.

It’s true that TSS, a complication of bacterial infections, has been associated with tampon use, but it doesn’t only happen in women and you don’t need to stop using tampons just because of this article. Here are questions you might have.

What causes TSS?
It's not tampons alone. A person needs to have a specific strain of staph bacteria (staphylococcus aureus) in their vaginal flora to contract TSS, says Mary Jane Minkin, M.D., F.A.C.O.G., and clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine. If they do, the staph can multiply in the tampon’s absorbent fibers, producing a harmful toxin.

How many people have staph in or on their bodies?
About 20 percent of people have the bacteria on their skin and more have it in their nose, according to a 2011 study. Experts don’t know how many women have it in their vaginal flora.

Should I get tested for staph at my next gyno visit?
No. Dr. Minkin says you could easily have cultures taken, but vaginal flora change throughout your cycle, so you would need regular, ongoing cultures to check for it (which, she says, aren't necessary for prevention).

How many cases of TSS are there annually? How many are estimated to be related to tampons?
Staph-related TSS cases in the United States have to be reported to the Centers for Disease Control and Prevention. In 2014, there were 59 cases reported and there have been 26 this year thus far. But TSS can also occur following skin infections, burns, nosebleeds (where packing was used to absorb the blood), or after childbirth or surgery, according to the National Institutes of Health (NIH).

While it’s not known how many cases of TSS were associated with tampon use, the NIH estimates that, in general, about half are menstruation-related. It’s a very rare event when you consider the millions of women who use tampons every year without incident, Dr. Minkin says. “For people to say, ‘Never again!’ Well, ‘Okay, don’t drive your car because you might get killed. Or don’t fly on an airplane because you might get killed,’” she says. “As long as you change your tampon regularly, it shouldn’t be much of an issue.”

What are the exact symptoms?
While TSS is rare, you should still know when to get medical care. The symptoms of TSS include high fever, rash, muscle aches, vomiting or diarrhea, confusion, low blood pressure, and, later, multiple organ failure (usually the kidneys and liver). Dr. Minkin says if, within a few days of your period, “you start feeling lightheaded, ready to pass out, you’re vomiting, and you have a high fever, then you want to talk to the doctor.”

What can you do to prevent TSS?
The recommendation by gynecologists is to use the lowest absorbency you can (and, yes, the terms regular, super, and super plus are standardized). And, contrary to claims in the Vice story, Dr. Minkin says it doesn’t matter if the tampon is made of synthetic or natural fibers. “There’s no data that shows there’s a difference,” she says. “If you want to [use cotton tampons], it’s fine. I certainly can’t say it’s bad. Or just use a pad or a menstrual cup if you’re nervous.”