What is Toxic Shock Syndrome? Spoiler alert: not Britney-related!


What is Toxic Shock Syndrome? Spoiler alert: not Britney-related!

Toxic shock syndrome is usually characterised as a disease caused by neglecting period hygiene and keeping a tampon for too long inside the vaginal canal. In fact, TSS is a very rare disease, but it can affect anyone! There is a very wide spectrum of risk factors — weak immunity system, skin infections, open wounds, etc. However, using tampons in the wrong size or with too high absorbency level and holding them for too long are indeed the most common ways to catch the toxic shock syndrome. Why?

Dominika Olchowik

Published: 3.02.2021 6 minreading time

TSS illustration by Jarek Danilenko

Illustration: Jarek Danilenko

And no — this is not only a tampon-related infection!

What is toxic shock syndrome (TSS)?

During menstruation, when we use different types of free blood flow protection, it is very easy to damage and scratch the vagina’s lining, especially with a tampon. Such abrasions are the open door to transporting bacteria and toxins straight into the circulatory system. What’s important — other period methods (mostly the internal ones like menstrual cups) can also cause TSS, but it’s even rarer than with a tampon. Menstrual cups collect the blood rather than absorb it, so the cup itself isn’t a warm room for bacteria growth. It is very important to implement certain hygienic and safety rules, to not only prevent the blood leaking but also to avoid the risk of getting toxic shock syndrome during period.

The more you know about toxic shock syndrome (TSS), the better you are protected from it. The period itself can be stressful and painful — we don’t need anything else to worry about, do we? :)

Remember — it is not forbidden to use tampons! They were created to ease our lives, not to  traumatise and keep us in constant stress.The thing is to balance our menstrual needs with taking proper care of our bodies.

We are here to rationalise all the fears and help you understand what TSS is. Remember, if anything odd draws your attention, don’t hesitate to seek medical advice, as it can be a life-threatening condition for the organism.

What causes toxic shock syndrome?

Toxic Shock Syndrome is a complication of an internal bacterial infection. Two main groups of bacteria cause TSS:

  • Staphylococcus aureus

  • Streptococcus pyogenes

I know, I know — these Latin names sound very scientific and disturbing, but actually these bacteria casually inhabit our skin, nose, and mouth without causing any particular harm! However, it drastically changes as soon as they enter the blood flow and spread the toxins all over the body through the veins. Tricky bastards.

Toxic shock syndrome is most likely to happen to menstruating women who use tampons, especially the super absorbent ones, but it can also affect those who do not use tampons or don’t menstruate in general! It can occur in association with a skin infection, internal contraception, or any type of post-surgical wounds that may be a fast route for spreading the bacteria into the blood flow.

Can you get the toxic shock syndrome from leaving a tampon in for too long?

Yes — if you keep a tampon inside your vagina for too long, it creates a warm and moist space for bacteria to start producing toxins — which then can be easily transmitted through the vagina lining or the uterus straight into the blood flow. If you keep a high absorbency tampon for too long, it will collect not only period flow but also the vagina’s natural lubricants. This changes the level of pH and makes it even more fragile.

This topic needs a little bit of introduction, as this question is for sure the most frequently asked by everyone who is aware of toxic shock syndrome. This will also help us understand the whole issue. 

Why do we link tampons with TTS so much now that we know that it isn’t the only way to catch this dreadful disease?

Let’s go back in time a little bit.

In 1980 in the United States of America there was a drastic rise of toxic shock syndrome cases. Back in the days, there were fewer options to choose from — tampons were mainly dedicated for a bigger flow and had very high absorbency. Therefore, women who had lighter menstrual flow were still using the super-absorbent tampons, as they had very limited options to choose from. People also believed that high absorbency tampons didn’t need to be changed throughout the day as it was advertised and suggested on national television. Later on, scientists and medical experts confirmed that most of the toxic shock syndrome cases were linked with incorrect tampon use and infections that it caused.

Tampons should be changed at least every 4 to a maximum of 8 hours.

Also, pick the lowest absorbency tampons, especially during the beginning and end of your period. 

Psst, if you look for safe, ecological, and comfortable tampons — check ours out!

How do I know if I have TSS? — signs and symptoms of toxic shock syndrome

TSS causes a lot of symptoms that may vary from person to person. They may be easily attributed to the typical flu. However, if you experience any of the below during period, do not hesitate to contact a medical doctor! Ignoring the symptoms of TSS can lead to hypotensive shock, which causes organ failure that eventually can be fatal for the patient.

We have previously mentioned two main groups of bacteria responsible for toxic shock syndrome. Even though they both cause similar symptoms, some reactions may differ.

Staphylococcal TSS symptoms may include:

  • Sudden high fever (it usually spikes suddenly and remains elevated)

  • Low blood pressure

  • Headache and muscle aches

  • Sunburn-like rash that covers large areas of the body

  • Shredding of the skin, especially on palms and soles

  • Nausea and vomiting

  • Fatigue and disorientation

  • Red eyes, mouth, and throat

The second one, streptococcal toxic shock syndrome, usually affects people with very weak immune systems. It can happen after chickenpox or any type of skin infection. The first symptom is usually a severe pain that comes suddenly. Sometimes streptococcal TSS patients also experience shedding of the skin on palms and soles (like with the previously mentioned infection), but it is not a strict rule.

Other symptoms of TSS caused by group A streptococcus bacteria may include:

  • Difficulty breathing and confusion

  • Very low blood pressure

  • Bruising all over the body

  • Rash (flat and red, resembling a sunburn)

How to reduce the risk of getting TSS?

Those who do not menstruate should follow very basic hygiene rules. Don’t underestimate the power of washing your hands thoroughly!

Here is a set of rules that may save you from toxic shock syndrome while on period.

  • Wash your hands regularly, especially during menstrual hygiene and changing the period protection (sanitary pads, tampons, menstrual cups, etc.)

  • Use period protection right after you unpacked it — avoid exposing it to any more bacteria!

  • Take good care of any wounds you have — keep them clean and covered

  • Avoid using super-absorbent tampons! 

  • Don’t put any force while putting a tampon in — you might scratch the vagina insides and unwittingly spread the germs

  • Alternate between a pad (or pantyliners) and tampon use — switch to a pad for night protection if possible

Be attentive! If any symptoms of toxic shock will occur, seek medical advice immediately! 

Can toxic shock syndrome go away on its own?

TSS is a rare, but life-threatening disease. As soon as any disturbing symptoms occur (especially after using a tampon), contact a medical doctor right away! Treatment for TSS is a life-saving procedure that can be done only in a medical facility. TSS gets worse very quickly and, without prompt treatment, this disease may become fatal.

The hospital treatment for toxic shock syndrome needs to be tailored for a patient's needs — it all depends on how big of devastation has been made in the body as TSS may cause some serious organ damage.

Standard treatment procedures for toxic shock syndrome effects include:

  • Immediately giving the patient antibiotics and intravenous IV fluids to treat the hypotensive shock

  • Surgical care of any infected wounds

  • Medications to bring back the healthy blood pressure

  • Sometimes patients experience major organ failures caused by infection — in these cases treatments like e.g. dialysis are necessary

Toxic shock syndrome sounds all scary…

...but definitely shouldn’t steal your sleep at night. The key is to rationalise the problem, dedicate some time to practising menstrual hygiene and self-care, observe your body, and finally — to react if anything odd occurs.


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