Frequently Asked Questions

Got some questions? What is Toxic Shock Syndrome (TSS) and what causes it?
Can the risk of tampon-related TSS be reduced?
Who can get TSS?
What are the Symptoms?
What is the Treatment?
Choosing The Right Absorbency
How dangerous is TSS?

I thought that you only got TSS if you forgot to change your tampon. Is this true?

Any woman may develop TSS when using tampons as directed by the manufacturer's instructions if she is carrying the particular strain of bacteria that produces toxins and if she has not developed immunity to these toxins.

The exact combination of circumstances in which toxin production occurs in the vagina of individual women is not known. It is therefore not possible to state any completely safe time limits on the use of a tampon, although it could be assumed that the longer a tampon is left in place or the more tampons are used continuously, the greater the chance of toxin production starting. This is why we recommend keeping tampon use to a minimum and breaking the use regularly by using a sanitary towel/pad.

All known victims of TSS followed the manufacturers instructions on usage implicitly, but they still became seriosly ill or even died.

We think that there are several reasons why people think that a "forgotten tampon" causes Toxic Shock Syndrome:-

Can anyone get TSS?

TSS can affect anyone - men, women or children.
However, only women and girls use tampons.

Given that anyone can get TSS...
Why don't you campaign for more awareness about TSS which is not tampon related?

In 1991 we knew, from our own experience, that very few women, in the UK, knew that there was any risk from using tampons in accordance with the manufacturers' instructions. We felt that there was the need for an awareness campaign aimed at tampon users, their families, friends and employers.

TSS associated with tampon use has always been responsible for at least 50% of all TSS cases and therefore this was the area where we focused our awareness campaign.

Other causes of TSS are varied and may involve different toxins. In most cases the victims are already under medical supervision eg. following surgery, severe burns and after childbirth, so that public awareness was not such a priority. However, TSS can also develop following minor abrasions, burns and insect bites, and we would wish to offer whatever support and information we can to highlight these cases.

We were also reluctant to be sidetracked into this arena by the tampon manufacturers.

Can you catch TSS from other people?

No. TSS is not a contagious disease.

What is the link between TSS and tampon use?

The link is not clearly understood. However, tampon research highlights three high RISK FACTORS: high absorbency, continuous use and low body immunity.

  • Absorbency: the higher the absorbency the higher the risk; the lower the absorbency the lower the risk. That is why a woman should always use the lowest absorbency tampon for her menstrual flow. It also accounts for the high number of deaths due to super-absorbent tampons in 1980.

  • Continuous use: women should not use tampons continuously during a period. It is recommended that the most convenient time to break the continuous use is at night, by using a sanitary towel/pad.

  • Low immunity: this is the factor that you cannot control as it may vary from time to time. It is generally understood that immunity improves with age therefore girls are at a higher risk that older women.

  • Is it possible to get TSS more than once?

    Yes. A person who has had TSS can develop it again. If a women or girl has had TSS in the past, it is advisable not to use tampons again.

    Menstrual TSS recurs in around 30% of cases. Dr Mary Andrews of the Dartmouth-Hitchcock Medical Centre in New Hampshire, advises that symptoms were most likely to return in women who were not treated during their first attack, and continued to use tampons. Two thirds of Dr Andrews' study group experienced a recurrence within 5 months, although only 16% of women who were treated had recurring symptoms of TSS.

    The Symptoms

    What are the symptoms of TSS?
    Symptoms can be similar to flu or food poisoning, but they can become serious very quickly.

    The symptoms:

    What should I do if I get these symptoms?

    If you have any of these symptoms and are using a tampon you should, remove and save your tampon and seek immediate medical attention (preferably at an emergency HOSPITAL). Tell the doctor that you have been using tampons and suspect TSS (Take a TSS information leaflet with you).
    Don't worry about wasting the doctor's time, you could be saving your life.

    What Is The Treatment For TSS?

    With early diagnosis, TSS can generally be effectively treated with antibiotics and other medication to counteract the symptoms.

    Professor Joan Chesney, Head of Paediatrics at the University of Tennassee said in September 1997 that concerns that Staphylococcus aureus could become resistant to antibiotics have so far proved unfounded. Tests on TSS-associated strains of S-aureus at the Dartmouth-Hitchcock Medical Center in New Hampshire failed to find any methicillin-resistant Staphylococcus aureus (MRSA), the strain which has caused so many problems for hospitals in Europe and America. All 62 samples from menstrual and non-menstrual cases referred to the D-H Medical Center between 1984 and 1995, were susceptible to two key antibiotics - oxacillin and clindamycin - although only a handful would have responded to treatment with penicillan.

    Standard therapy for TSS continues to be on high-dose antibiotics, usually with a beta lactam agent, with or without clindamycin or a related drug. You also need to stop toxin production which can be best done with a protein synthesis inhibitor such as clindamycin, gentamycin, erythromycin or clarithromycin. Introvenous fluids are another essential aspect of management, but doubts remain over the value of introvenous immunoglobulin (IVIG) injections as they carry the risk of side-effects.

    Choosing the Right Absorbency

    When using tampons, it's important to choose the lowest absorbency necessary for your menstrual flow. Because the amount of flow varies from day to day, it is likely that you will need to use different absorbencies on different days of your period. Selecting the right absorbency comes with experience, but as a guide, if a tampon absorbs as much as it can and has to be changed before 4 hours, then you may want to try a higher absorbency. On the other hand, if you remove a tampon and after 4-6 hours white fibre is still showing, you should choose a lower absorbency.

    Research indicates that tampons should not be used continuously during a period as continuous use is a high risk factor. The most obvious time to break this continuous use is at night. AKTA recommends the use of a sanitary towel at night. However, if you choose to use a tampon at night, choose the lowest absorbency needed, insert a fresh one just before going to bed and remove it as soon as you wake up in the morning. Slim line tampons are quite absorbent for their size, so it is highly recommended that young girls do not use tampons at night.

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