Last updated date: 10/20/2020
Author, editor and medical expert - Klimovich Elina Valerievna.
American doctors first reported the possibility of toxic shock syndrome (TSS) from tampons in 1978. Since 1980, pathology has been identified as a separate disease in the United States. And three years later, this problem became so acute that it was brought up for discussion at an international conference1. Although only 14 out of 100 thousand women develop this serious condition1, we decided to tell you more about it so that you can avoid this serious problem.
Why do tampons cause toxic shock?
The cause of toxic shock syndrome is Staphylococcus aureus (Staphylococcus Aureus), which lives in the vagina of 10% of healthy women. But TSS is caused only by staphylococci that are capable of producing a toxin.
To neutralize staphylococcal poison, the immune system synthesizes antibodies. If the immune system fails, bacterial poisons enter the bloodstream and cause intoxication1.
98% of women who test positive for vaginal staphylococcus have antibodies against its toxins. Others produce few or no antibodies, putting them at risk of developing TSS.
In the absence of immune protection, TSS may be caused by more than just hygiene products. The impetus for the development of shock is sometimes abortion, childbirth and gynecological operations. In all these cases, a wound or “pocket” of dead cells appears, in which staphylococci can settle and multiply.
Symptoms of TSS
Early signs of TSS may appear within 48 hours of insertion or removal of tampons1. Most often, toxic shock develops if a woman uses a highly absorbent tampon and does not replace it with a new one on time.2
The disease develops acutely. Typical signs of the syndrome include:
- fever up to 39 0C;
- drop in blood pressure;
- rashes on the body1.
The rash is located in various parts of the body: on the face, torso and limbs. At first it resembles a mild sunburn. After 3-7 days, the skin begins to peel off2, and on the palms and soles it begins to peel off in patches, like peels1. Also, in the acute period, TSS may cause concern:
- increased skin soreness;
- “aches” and pain in muscles and joints;
- weakness;
- drowsiness;
- lethargy;
- confusion;
- nausea and vomiting1.
Sometimes there is redness of the skin around the vaginal opening and purulent discharge from the genital tract. But more often there are no symptoms of a genital tract infection, because staphylococci do not cause local inflammation1.
Treatment
In order for the treatment process to be as effective as possible and not to drag on for many weeks, it is necessary to contact a medical institution for help at the moment when the first symptoms appear and suspicion of TSS arises. In this case, doctors can guarantee a quick recovery and easy resolution of the problem.
When a patient shows signs of toxic shock, he is urgently hospitalized to provide care and prevent the spread of infection. The patient is sent to the intensive care unit. First of all, the cause of the disease is eliminated - an object placed in the vagina (tampon or menstrual cup, diaphragm, etc.).
The main stages of treatment include combating the spread of infection and measures aimed at maintaining organ function and stabilizing the patient’s condition. With timely detection of the disease and early initiation of therapy, you will only have to spend a few days in the hospital. In advanced cases, treatment lasts up to several weeks.
Treatment of infection
Immediately after hospitalization and elimination of the foreign body from the vagina, the mandatory process of decontamination begins, that is, disinfecting the body and destroying harmful microbes. It occurs by washing the organs affected by the infection.
Toxic shock syndrome, like many other infectious diseases, occurs with large loss of fluid. In medicine, this is solved by installing droppers that help restore the water-alkaline balance.
Antibiotics fight the infection itself. Depending on the severity of the condition, as well as the type of microorganisms that caused TSS, the patient is prescribed the following drugs and their combinations:
- clindamycin and beta-lactam;
- vancomycin;
- clindamycin and oxacillin;
- daptomycin and clindamycin;
- nafcillin;
- linezolid.
These medications help eliminate pathogenic foci and also reduce the likelihood of relapses. Properly selected antibiotics reduce the risk of death.
Maintenance therapy
In addition to eliminating the infection, it is also important to provide the patient with conditions in which the body can function as usual. Oxygen tanks are used to prevent dizziness, fainting and suffocation caused by toxins.
A person breathes its components through a special mask for a certain amount of time, which helps normalize breathing.
To maintain the required level of fluid in the body, the patient is prescribed IVs. The procedure helps eliminate disturbances in the water-alkaline balance and prevent dehydration. The patient's body also needs fluid to normalize the functioning of internal organs and protect them from damage caused by toxins. Droppers may be prescribed as a treatment for low blood pressure.
Dialysis
In humans, the kidneys cleanse the body of harmful substances. They are the ones who filter out the accumulated residues of heavy metals, poisons and other compounds in the body that interfere with normal life and threaten health, and then remove them along with urine.
Hemodialysis
However, with the development of TSS, actively reproducing bacteria release so many toxins that the kidneys can no longer cope with cleansing the body on their own. In addition, the disease can affect various systems, affecting them with infection and depriving them of functions important for life. The urinary organs are also at risk.
If, as a result of toxic shock, the kidneys can no longer cope with the load, the patient is connected to a dialysis machine. This allows you to artificially remove compounds accumulated in the body, significantly reducing the percentage of their content.
Cleaning infected tissue
The infection is spreading rapidly. Often, having affected the site of origin, it spreads to other tissues, resulting in damage to the skin or entire limbs. There are cases where toxic shock led to the amputation of legs, arms and fingers.
However, the spread of infection does not always end with the removal of the affected part of the body. In some cases, when the damage has not yet reached a severe form, it is sufficient to carry out a procedure for removing non-viable tissue. To do this, they are dried and then cleaned, neutralizing and preventing the spread of microbes.
When to see a doctor
Of course, all of the listed symptoms of TSS rarely occur at the same time. It also happens that the first signs of shock appear only 20 days after menstruation1. Therefore, always monitor your health and be sure to call a doctor at home if you develop fever, body aches, weakness, dizziness or skin rash. Even if the cause of the illness turns out to be a common ARVI, it is better to play it safe. Be sure to tell your doctor that you use tampons during your period. This will help diagnose TSS. With timely seeking medical help and proper treatment, complications can be avoided1.
How to treat toxic shock syndrome?
First you need to make a correct diagnosis. Next, understand that the disease must be fought in two directions: with TSS itself and with its consequences for other organs.
Next, the victim needs urgent medical assistance. Treatment usually lasts several days (in rare cases, a couple of weeks).
The first thing the patient will have to drink is a course of a combination of antibiotics that are administered intravenously. Since the patient has problems with antibodies, he needs to be given immunoglobulin - blood with a large amount of antibodies.
Secondly, he needs an oxygen cylinder to stabilize the breathing process.
Thirdly, in case of poor kidney function, a blood filtering device is needed.
Fourthly, it is necessary to cleanse the parts of the skin damaged by toxins. In extreme cases, it may be necessary to resort to surgical intervention, including amputation of the legs.
How to reduce your risk of developing TSS
In 97% of cases, TSS is treatable, but the disease can develop again1. Therefore, if you have had toxic shock, don't use tampons - choose sanitary pads.
To reduce your risk of developing TSS from tampons, follow these guidelines:
- do not use a tampon with damaged individual packaging;
- open the wrapper only with clean hands;
- do not place the tampon on a surface that may be contaminated with bacteria - hold it in your hand;
- tampons are intended only for menstrual flow; for normal flow, replace them with panty liners;
- change the hygiene product every 4 hours, do not leave it in the vagina at night, and also if you do not have the opportunity to quickly replace it;
- choose only high-quality hygiene products, such as ob®;
- Always consider the amount of menstrual blood and do not use highly absorbent tampons if there is little discharge.
Everything we've told you about TSS isn't a reason to stop using tampons. ob® tampons are a modern, safe hygiene product that makes life easier for millions of women. Among ob® tampons you can find convenient options with different absorbent capacities. Use them and follow safety rules.
Possible complications and consequences
If treatment for TSS is not started on time, the following complications may occur:
- Anaphylactic shock, which leads to a reduction in oxygen supply to the blood and vital organs.
- Acute respiratory failure. It causes fainting, convulsions, a sharp decrease in blood pressure, and respiratory arrest.
- Changes in blood composition. This leads to the formation of many blood clots in the body. Subsequently, the patient suffers from thrombosis and thrombophlebitis. If a blood clot ruptures, death occurs almost instantly.
- Liver and kidney failure. These organs are the first to encounter toxins. At first they try to fight bacteria and harmful microorganisms, but this cannot last long. As a rule, on days 7–10, without proper treatment, a woman experiences failure of these organs. It is no longer possible to do without resuscitation and transplantation.
To avoid complications, do not bring the situation to a critical point. If you notice any unpleasant symptoms, remove the tampon from the vagina and consult a gynecologist.
