Toxic shock syndrome: tampon, symptoms, streptococcus

Toxic shock syndrome or TSS is an infection caused by bacteria, most commonly Staphylococcus aureus. It usually occurs during menstruation when using vaginal devices (tampons, menstrual cups) in women carrying the bacteria responsible for STC. But also following invasive group A streptococcal infections which can be associated with a streptococcal toxic shock syndrome (SCTS), indicates Public health France. How do you know you’re having a toxic shock? When does toxic shock occur? Is it possible to have a toxic shock with a sanitary napkin? How to treat toxic shock?

Definition: What is Toxic Shock Syndrome (TSS)?

Toxic shock syndrome (TSS) is a infectious disease caused by bacteria: staphylococcus aureus (staphylococcus aureus). This bacterium produces a toxin, which enters the bloodstream before reaching one or more organs. Note that this bacterium is naturally present in our environment and remains harmless if it remains on our skin, for example. On the other hand, when it manages to introduce its toxin into the bloodstream, it can then reveal its pathogenic potential.

What is staphylococcal toxic shock?

Staphylococcal toxic shock is caused by Staphylococcus aureus (Staphylococcus aureus) It is characterized by high fever, rash followed by skin peeling, hypotension, vomiting, diarrhea and potentially leads to multisystem organ failure.

What is streptococcal toxic shock?

Strep toxic shock is caused by group A streptococcus (Streptococcus pyogenes). It can be manifested by hypotension, renal, pulmonary or respiratory damage.

What are the symptoms of toxic shock syndrome?

Toxic shock syndrome is characterized initially by symptoms flu-likeassociated with digestive symptoms:

• A feeling of malaise and/or dizziness with headaches,
• Digestive disorders, such as nausea, diarrhea and vomiting,
• Sometimes fever (38.9°C or more),
• muscle and joint pain,
• A red rash that looks like a sunburn.

In a second time :

• Very low blood pressure
• An acceleration of the heart
• A confusion

Only women carrying the bacteria responsible for STC are affected, i.e. 4%.

Risk factors: which women are likely to have an STC?

Only women carrying the bacteria that produces the toxin responsible for STC are affected, i.e. less than 4% of French women. But conversely, all women carrying the bacteria do not necessarily have a toxic shock. “So there must be something else, probably present in the vaginal flora of women carrying the bacteria, which causes STC. But what exactly, we don’t know. We are just doing research to find out more.“, specifies Anne Tristan.

Toxic shock and forgotten tampon: what risk?

On 20 January 2020, ANSES published the results of his expertise on the safety of internal intimate protection (tampon and menstrual cup). These tests revealed the presence of chemicals in tampons and menstrual cupsbut without exceeding health thresholds. Nor would there be a direct link between the physico-chemical properties of the materials of these intimate protections and an increased risk of toxic shock syndrome. For the Doctor Tristan, in any case, improper use of tampons is responsible for toxic shock. In fact, when the tampon is too absorbent and/or not changed regularly, the bacteria have more time to multiply. So, should we be afraid of tampons? Toxic shock syndrome remains very rare as confirmed by Anne Tristan: “At the reference center for staphylococci, we identify 20 to 30 cases at most each year“. And to add that “in normal time, even if the TSS is serious and requires admission to the intensive care unit, the evolution is always favorable and without sequelae“.

Can you do a toxic shock with a sanitary napkin?

Indeed, the risk is lower with sanitary napkins because they are less of an obstacle to blood flow compared to tampons and less favor the development of staphylococci, but the problem is that women, especially younger ones, are often reluctant to wear them. As to menstrual cups, they do not protect against the risk of STC. “We had cases of women who wore them“, she points out. As with tampons, it was misuse that triggered the infection. Because although the cups are natural, “the instructions for use and hygiene must be followed, namely: do not keep them too long and clean them well.“ Especially since, as our interlocutor points out: “We have less hindsight with the cups.“

If symptoms occur, you should immediately remove the tampon or cup and go to the hospital. The doctors will be able to take you in as soon as possible, give you intravenous treatment to maintain your blood pressure, then consider setting up a antibiotic treatment, to prevent the toxin from spreading to vital organs. In the case of Lauren Wasser, an American model who had both legs amputated in 2012 following a toxic shock, the bacterial toxin had reached the heart and led to gangrene in the legs, that is, tissue necrosis. That’s why the doctors had no choice but to amputate him.

Public Health France has issued its recommendations to limit the risk of toxic shock:

► It is essential to changing tampons or menstrual cups regularlythat is every 4 hours, even at night.

► During the night, favor external protection such as sanitary napkins.

► Properly adapt the type of tampon to its flow. “The more absorbent the tampon, the more it obstructs blood flow and the more chance bacteria have to multiply“, emphasizes Anne Tristan. Moreover, if the SCT mainly affects young girls, on average they are around 20 years old, it is because they too often wear protection not adapted to their flow. “They use heavy flow tampons for fear of leaking, which is not indicated“.

► Also remember to always wash your hands with soap. (or with a hydro-alcoholic solution) before inserting a tampon or a cup and removing them.

► Avoid using tampons in case of a history of menstrual staphylococcal toxic shock.

► Wait until your period starts before using a tampon. Do not use a tampon as a precaution, even if you are expecting your period, or to absorb other losses.

Thanks to Doctor Anne Tristan, co-director of the National Staphylococcal Reference Centera unit attached to the Institute for Public Health Surveillance (InVS),