Ask the Doctor: ‘I’ve been scared of using tampons out of fear of getting Toxic Shock Syndrome. Is it common, how can I prevent this, and is it treatable?’

“I’ve been scared of using tampons out of fear of getting Toxic Shock Syndrome. Is it common, how can I prevent this, and is it treatable?”

Answer from Dr Stephen Frohlich, Consultant Intensive Care Medicine & Anaesthesiology, Beacon Hospital.

Unless you or someone close to you has suffered from Toxic Shock Syndrome (TSS), people usually hear in the media about women who have gotten sick after they developed an infection from the use of a tampon. Let’s break down what it is, how common it is, what happens if you do get it, and how to prevent it from happening at all.

TSS can be a result of almost any serious infection in the body. It is classified into two groups depending on the bacteria that cause it. These are streptococcal TSS and staphylococcal TSS. It is this second group that can result from the use of tampons, but the use of menstrual cups, diaphragms or contraceptive sponges can also be a risk factor.

In TSS, the finely balanced processes in the body become completely unstable because of a poison made by the bacteria, and the body struggles to perfuse its organs correctly. This goes some way to illustrating how serious the consequences of TSS can be.

Thankfully, the condition is very rare. Precise Irish figures are difficult, but in the UK, it seems that just under 1 in a million people per year develop it. This has improved over time, which is largely due to changes in the manufacture of tampons and the clearer guidance issued around their use. In almost all of these cases, bacteria grow in a used tampon that has been in place for more than one day.

Blood is full of substances that can allow bacteria to thrive in certain circumstances. The bacteria can release a toxin called TSS toxin-1 (TSST-1). Over 90% of people actually develop antibodies against this by the time they are in their 30s. However, if people who have not developed this antibody are exposed to the toxin, they are at risk of developing TSS.

Unfortunately, most of the symptoms of the early stages of TSS are not very unique to any particular illness. A person developing it might have fevers, aches and pains, diarrhoea or vomiting, and occasionally a rash. However, if this occurs in a person and there is the extended use of a tampon, doctors will highly suspect that TSS is developing.

Anyone being investigated will have blood tests to look for both bacteria and biochemical evidence that their organs are not being perfused correctly. They might have X-rays to see if their lungs are being affected.

As part of their treatment, they will get antibiotics, have any tampons removed, and will probably spend some time in Intensive Care to get infusions of drugs that help their body maintain normal blood pressure. Even with all this, 5 – 10% of people who are seriously ill will not make it through the illness.

As has been said, the condition is very rare. The best course of action is the prevention of the condition developing in the first place. This is best done by frequently changing tampons during your period (approx. every 4 – 8 hours), but always read the recommendations that the manufacturer places on the packaging.

In summary, TSS is both very rare but extremely serious. The most effective treatment is prevention, so ensure that you read manufacturer’s guidance and change tampons frequently. By doing this, the chances of developing TSS are incredibly rare.

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