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Toxic Shock Syndrome (TSS) is an uncommon, but serious illness that was first recognized in the late 1970's. TSS is caused by a toxin (a poisonous protein). The toxin responsible for causing TSS is produced by a bacteria called staphylococcus aureus.

This bacteria is found harmlessly on the skin and mucous membranes of most people. While the presence of staphylococcus aureus does not necessarily lead to disease, it can result in the development of problems, such as skin infections (boils and abscesses), wound infections, blood infections and some forms of food poisoning. 

Even though the majority of TSS cases have been women under 30 years of age who use tampons (especially 'superabsorbant' tampons), TSS can occur in females who do not use tampons and in males as well.

The reasons for the association between TSS and tampon use remain unclear, but the number of reported cases of TSS has dropped dramatically since 'superabsorbant' tampons were taken off the market.

Tampon manufacturers have also started to include information about TSS in all tampon boxes. When TSS occurs in males, or females who don't use tampons, there is usually an association with a staphylococcal infection somewhere in the body (for example - an infected wound or a skin abscess). *
Symptoms of TSS may include:

·          sudden high fever

·          nausea and vomiting

·          diarrhea

·          headache

·          generalized aches and pains

·          dizziness and feeling faint (especially when rising from a lying or sitting                 position)

·          disorientation

·          a sunburn-like rash on the palms of the hands and the soles of the feet (the          skin on these areas generally peels about 1-2 weeks later)

·          extremely low blood pressure, rapid weak pulse (shock)

These signs should be reported to your doctor immediately -- if you can't reach your doctor, go to the nearest emergency department or call 911.
Complications of TSS may include - kidney failure, liver failure and even death ( in about 3% of cases ).
Preventing TSS: What You Can Do

You can help to reduce your risk of getting TSS by:

·          not using tampons. 

·          if you use tampons (even those that are not 'superabsorbant'):

          read the instructions and warnings contained in your tampon package    
       carefully and follow the instructions exactly
          select a tampon with the lowest absorbency rating possible to control your             menstrual flow

           change tampons frequently (generally every 4-8 hours)

          alternate tampon use with sanitary napkin use

          use sanitary napkins during times when it is unlikely that you will change              tampons frequently (e.g. at night) 

          if you notice the signs of TSS while you are wearing a tampon, remove the            tampon at once and seek medical attention

          practice good hygeine and wash your hands thoroughly before
       inserting a tampon.

·          if you have had TSS in the past, check with your doctor before using                     tampons again or using cervical caps, diaphragms or contraceptive                      sponges. 

·          speaking with your doctor, pharmacist or other health care professional if              you have questions about TSS or tampon use.

·          making sure that any sores or skin wounds are kept clean.

·          reporting any skin or wound infections that appear to be getting worse,                   instead of better, to your doctor.
Treatment of TSS
The treatment of TSS usually involves:

·          the use of antibiotics to kill the staphylococcus bacteria that are producing           the toxin

·          support measures, such as intravenous fluids and medications to treat the            effects of the toxins (low blood pressure, shock, etc.)

·          prevention and treatment of complications.
General reference - The Canadian Medical Association - Home Medical Encyclopedia, Dr Peter Morgan (Editor), The Reader's Digest Association (Canada) Ltd., Montreal, 1992. 
* Kniffin WD Jr, Smith R, Stashwick CA., Journal of Adolescent Health Care, 'Toxic shock syndrome in three adolescent males', March, 1990, 11(2):166-9.
This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.
Calgary  Health Region - Learning and Development
Reviewed June 2001

              When A Tampon
            Can Make You Sick
  What you must know about Toxic Shock Syndrome
Intimate Health Care For Women