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What Is Toxic Shock Syndrome?

Toxic shock syndrome is a sudden, potentially fatal condition brought on by the release of toxins or poisonous substances from an overgrowth of a bacterium called Staphylococcus aureus, which is commonly found in many women. It is widely known to affect menstruating women, especially those who use superabsorbent tampons. If affected, the body responds with a sharp drop in blood pressure that deprives vital organs of oxygen and can lead to death.

This disease reached the headlines in the late 1970s and early 1980s after the deaths of several young women who were using a brand of superabsorbent tampon that was later removed from the market.

Toxic shock syndrome is still primarily a disease of menstruating women who use tampons — especially superabsorbent tampons; however, it has also been linked to the use of menstrual sponges, diaphragms and cervical caps. A woman who has recently given birth also is at increased risk for developing toxic shock. But the condition is not limited to these factors alone and over the past 25 years there has been an increasing proportion of nonmenstrual cases. Its victims include both men and women who have been exposed to Staphylococcus aureus bacteria while recovering from surgery, a burn or an open wound or the use of a prosthetic device.

More than a third of all cases of toxic shock involve women under 19, and up to 30% of women who have had the disease will suffer a recurrence. The reason for this is unclear; however, it means that if you have ever suffered toxic shock, you must be especially alert to the symptoms of its onset so that you can get immediate medical care.

People who die from toxic shock are killed by the body's sudden response to the toxins released by Staphylococcus aureus bacteria. Victims suffer what is known technically as hypotensive shock, in which the heart and lungs are overburdened to the point that they stop working.

If you are menstruating and have a high fever with vomiting, especially if you have been using tampons, you must get medical help right away. If you are using a tampon, menstrual sponge, diaphragm or cervical cap when you are taken sick, remove it immediately, even before calling your doctor.

What Causes Toxic Shock Syndrome?

The primary cause of toxic shock syndrome is a toxin produced by the bacterium Staphylococcus aureus. This organism is one of several related staph bacteria that often cause skin infections in burn victims and hospital patients weakened by surgery. These bacteria are not rare; in fact, Staphylococcus aureus is normally — and harmlessly — present in the vagina.

Exactly why and how Staphylococcus aureus causes toxic shock syndrome is not completely understood. What is known is that two conditions are necessary: First, the bacteria need an environment in which they can grow rapidly and release toxins. Then the toxins must have a way of getting into the bloodstream, where they trigger serious, life-threatening symptoms.

One theory holds that a tampon saturated with blood is a supportive place for rapid bacterial growth. It also seems to matter what the tampon is made of polyester foam apparently provides a better growth medium than either cotton or rayon fibers.

In cases that involve the use of menstrual sponges, diaphragms and cervical caps, either the device had been in the vagina for an exceptionally long time — more than 30 hours — or, in the case of the sponge, pieces of the sponge remained in the vagina. (Either situation may provide a favorable environment for growth.)

The way in which bacterial toxins enter the bloodstream may also be related to tampon use. According to researchers, sliding a tampon into place in the vagina may make microscopic tears in its walls, rupturing tiny blood vessels. A superabsorbent tampon — especially if it's left in place too long, or if it is used when the menstrual flow is light — can dry out the vagina, making such tearing even more likely.

Researchers investigating the causes of toxic shock syndrome have ruled out feminine deodorant sprays and douches, underwear, and other clothing. The condition is also unrelated to the victim's menstrual history, drug or alcohol use, cigarette smoking, swimming or bathing, or sexual activity.

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