Dr. Nesochi describes how toxic shock syndrome occurs and treatment on Teen Vogue.

7 Vital Facts You Need to Know About Toxic Shock Syndrome

Ferris Bueller was preaching to the choir when he proclaimed, “life moves pretty fast.” Between work, school, and social lives, our minds may tend to slip the small stuff. We might forget to take out the trash on garbage night, or remember those extra-credit assignments mere hours too late. But, what happens if you forget about the tampon you have in?

When it comes to Toxic Shock Syndrome, forgetfulness can catalyze serious effects. Take Emily Pankhurst, who developed TSS after leaving a tampon in for 9 days. Fueled by the stress of exams, she forgot to remove her tampon, and inserted a new one instead. Emily’s situation was near death, but thanks to serious medical care, she survived.

Life moves fast, but the health of our bodies shouldn’t be compromised due to stress or exams. Daliya Khuon, MD, infectious disease specialist at Spectrum Health Helen DeVos Children’s Hospital, states, “each year, about 1 in 100,000 women between ages 15-44 years of age report a case of TSS associated with tampon use.” We asked three doctors our 7 biggest questions about Toxic Shock Syndrome.

What is Toxic Shock Syndrome?

“Toxic Shock Syndrome (TSS) is an extremely rare complication of a bacterial infection, caused by toxins produced by the staph bacteria,” says Dr. Sherry Ross, MD, OB/GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California. “Classically the syndrome is thought to occur in menstruating women but it can also affect men, children, and postmenopausal women. About 50% of the cases of TSS occur in menstruating women who use super-absorbent tampons.”

How does Toxic Shock Syndrome occur?

According to Dr. Nesochi Okeke-Igbokwe, MD, MS at NYU Langone Medical Center, “If a tampon is retained in the vagina for prolonged periods of time, it may create an environment for bacteria to grow very quickly. Bacterial overgrowth from staphylococcus aureus may produce a toxin that can be released into the blood stream.”

What are the symptoms?

“TSS typically starts with signs and symptoms similar to the flu, including fever (temperature 102°F), chills, headache, muscle aches, vomiting, or diarrhea. Women may also experience dizziness or lightheadedness when standing, or low blood pressure.” Dr. Antonella Lavelanet, OB/GYN physician at Boston Medical Center explains, “TSS is also associated with a rash that looks like a sunburn and then spreads to a more severe rash over the palms of your hands and soles of your feet. These symptoms usually start suddenly and progress quickly.”

What is the treatment of TSS like?

A case of Toxic Shock could result in a hospital stay. Dr. Okeke-Igbokwe says, “Removal of the tampon would be the first step in management of patients with TSS as a result of prolonged tampon use. Treatment also includes antibiotics and supportive care. This means that you are essentially treating any symptoms that may arise in an infected patient. For example, if a patient becomes dehydrated then they would receive IV fluids.”

How often should a tampon be changed?

“Depending on the flow and amount of blood usually determines how long to keep a tampon inside the vagina. The general rule of thumb is to change your tampon every 4 to 8 hours. Tampons should never be left in for more than 8 hours since that increases your risk of TSS,” explains Dr. Ross. “Using the lowest absorbency tampon will also minimize your risk.”

Does the size of the tampon play into how often to change tampons?

According to Dr. Ross, “Size does matter with tampons when it comes to TSS. Even if you have a light flow you still need to follow the rules of tampon changing. Every 4 to 8 hours is the standard to ensure you don’t have any problems with foul smelling discharge or even worse, TSS. In menstruating women, a super-absorbent tampon left in the vagina for a long period of time may serve a breeding ground for the Staph bacteria that can ultimately end up in the bloodstream.”

What are the alternatives to tampons to lessen the risk of TSS?

Dr. Lavelanet suggests that, “there are several tampon alternatives including sanitary napkins or various types of menstrual cups (DivaCup or Mooncup). However, because TSS is caused by a bacterial infection, TSS may develop in women who use these alternative products too. If you are going to use tampons, it is important to change your tampon regularly and consider a sanitary napkin at night while sleeping or on days with light flow.”

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