The Menstrual Toxic Shock Syndrome (TSS) came to the attention of the medical community and to mass media around the '80s, when this syndrome was connected to the use of internal tampons. Even though incidences of this condition are dramatically lower today, it is still present amongst women in their fertile years. What is the Toxic Shock Syndrome, how and why does it appear, how can we prevent it? Continue reading for a comprehensive understanding of this condition.
What is toxic shock syndrome?
Toxic shock syndrome is a toxic condition that develops when bacteria such as Staphylococcus aureus or group A of streptococcus release toxins (like exotoxin TSST-1) into the bloodstream.
Studies show that in 90% of women diagnosed with TSS, the bacteria present was Staphylococcus aureus. The infection with this germ is usually brief and repetitive, and is transmissible to other persons.
Many individuals carry the Staphylococcus aureus bacteria without having any symptoms and around 10% of women are vaginal carriers of non toxic forms of it. The asymptomatic presence of these bacteria can be found inside the throat and nose and around the perineal area.
Toxic Shock Syndrome is characterized by symptoms such as: fever, low blood pressure, muscle pain, digestive problems and in worse scenarios, multi-organ system failure that ends in death.
In the majority of cases, the immune system plays an essential role as well.Studies revealed that patients with TSS are frequently unable to produce antibodies, leading to recurrence of the condition.
How it is connected with the use of tampons?
Studies show a higher risk of developing menstrual Toxic Shock Syndrome in women that use tampons than in women that use menstrual pads.
Factors that favor the penetration of toxin TSST-1 in the bloodstream are: vaginal irritation, a neutral vaginal pH, the use of intravaginal tampons that contain synthetic fibers with high absorbance characteristics, previous Toxic Shock Syndrome, postpartum or post abortion infection with Staphylococcus aureus or surgical wounds.
Studies propose different mechanisms of why tampons encourage the growth of these bacteria. Some say that the materials in high absorbency tampons extract magnesium atoms from the vagina and absorb them permanently in the fiber. Because of the low magnesium environment inside the vagina, the bacteria can release toxins.
Other studies say that super absorbent tampons would absorb air, specifically oxygen. The quantity of oxygen absorbed was able to change the vaginal environment, making it favorable for the growth of Staphylococcus aureus.
History and regulations that changed the incidence of toxic shock syndrome
The term “toxic shock syndrome” was first described in 1978, when several children presented this syndrome. This condition can appear in menstrual and non menstrual cases, menstrual cases being frequent in young, previously healthy women. TSS in adults that do not use tampons have also been reported, where this syndrome was linked to the use of a menstrual cup or an intrauterine device for contraception.
In 1980, the Center for Disease Control (USA) declared that TSS was associated with the use of super absorbent tampons. The development of ultra high absorbent tampons in the late 70’s, can be linked to the integration of women in the labour force. As most working women were in their fertile years, ways of managing menstruation in public had to be developed. Therefore, many women chose super absorbent tampons in favor of other menstrual products.
Over the years, many women died or got sick due to complications of the Toxic Shock Syndrome, after using superabsorbent tampons. The Food and Drug Administration (FDA) took measures and pressured Procter & Gamble to remove the Rely product from the market, the super absorbent tampon that was responsible for the majority of TSS cases. Unfortunately, other tampons with high levels of absorbance remained in stores.
In 1982, the Tampon Task Force appeared. This movement, comprised of manufacturers, consumer groups and feminist health advocates, had the goal of implementing uniform standards regarding absorption characteristics of tampons and labeling recommendations to the FDA. This movement was created as a result of studies showing tampons with higher absorptions being linked to higher prevalence of TSS.
After many years of research and pressure from consumer groups, in 1989 the FDA approved labeling of tampons based on the level of absorbency: junior absorbency, regular absorbency, super absorbency and super plus absorbency. This action, along with the influence of the Tampon Task Force, provided accurate information about tampons and ultimately helped women in choosing suitable tampons for their menstrual flow.
Tampon use recommendations
Thanks to developing better forms of tampons, the current recommended use of a tampon is for 2-8 hours, depending on the menstrual flow. Even with this, it is important to take into account that the use of a tampon for 8 hours during the day is different than from the night time use. During the night a use of 8 hours may increase the risk of TSS due to a different body position and accumulation of menstruation blood.
The discovery of TSS and further FDA regulations to label the level of absorbance on tampons, have transformed this condition from an unknown and little understood experience to a health issue of national concern, influencing industries, consumers, scientific research and governmental regulations. As current research shows evidence of the connection between the use of tampons and TSS, it is essential for this condition to be taken into account when women present themselves to emergency rooms with symptoms. Therefore, a pelvic examination should be included in the consultation. In case of a TSS, due to tampon use, the treatment needs to be fast and specialized. The removal of the tampon and an antibiotic therapy are the first steps in recovering. The treatment must be conducted after a diagnostic from a physician and under medical supervision. Always consult your doctor or go to the emergency room when you have symptoms that may indicate a Toxic Shock Syndrome.
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Sources: https://pubmed.ncbi.nlm.nih.gov/29040243/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5939143/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201014/ https://pubmed.ncbi.nlm.nih.gov/3635525/ https://catalystjournal.org/index.php/catalyst/article/view/28788
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