Ah yes, that dreaded 3-letter acronym that no person wants to hear used in reference to their own health: TSS, or Toxic Shock Syndrome, a condition of the vagina that one often needs to know about in order to avoid. Tampons and Toxic Shock Syndrome seem go hand in hand when you hear about TSS, but it’s more complicated than you might think. Herein lies the ins and outs of this undesirable force of nature…
In this article we discuss the following:
- What is Toxic Shock Syndrome?
- What Causes Toxic Shock Syndrome?
- How Common is Toxic Shock Syndrome?
- What Bacteria Causes Toxic Shock Syndrome?
- What does Toxic Shock Syndrome Feel Like?
- Toxic Shock Syndrome from Tampons
- Toxic Shock Syndrome vs Septic Shock
- Toxic Shock Syndrome Symptoms
- Toxic Shock Syndrome Treatment
- How to Prevent Toxic Shock Syndrome
- Best Tampons to Avoid TSS
What is Toxic Shock Syndrome?
To put it very bluntly, toxic shock syndrome (TSS) is essentially just a severe infection from tampons. This occurs when toxic shock syndrome bacteria is allowed to spread through the vaginal canals. The Oxford Dictionary offers a toxic shock syndrome definition as “acute septicaemia in women, typically caused by bacterial infection from a retained tampon or IUD”.
One may find this condition also being referred to as staphylococcal toxic shock syndrome. This is a more accurate term, scientifically speaking, but the general public tends to go with simply “toxic shock” or TSS.
What Causes Toxic Shock Syndrome?
To better understand how do you get toxic shock syndrome, we spoke with board certified dermatologist, Dr. Erum N. Ilyas, who was able to confirm that this condition is a little more complex than a case of accidentally left tampon in for 12 hours.
According to Erum, toxic shock syndrome is caused by either Staphylococcus aureus or Group A Streptococcus (also known as Streptococcus pyogenes). “This is a toxin mediated disease meaning that the toxins produced by these bacteria act as ‘superantigens’ and are capable of eliciting a strong inflammatory reaction.”
Erum goes on to explain that tampons have classically been linked to TSS, and in particular high absorbency tampons. “High absorbency tampons were not only left in place longer, they also became saturated with a high volume of blood making it possible for bacteria to overgrow. In spite of increased awareness, tampons are still the most commonly linked to TSS,” say says.
How Common is Toxic Shock Syndrome?
It may bring some peace of mind to know that TSS is estimated to affect 3-6 people per every 100,000 annually. This is based on numbers that have been monitored throughout the history of toxic shock syndrome.
Those aren’t bad odds, and while this is definitely not something you ever want to have to deal with during your health journey, the likelihood remains low. It may bring further peace to learn that TSS can occur outside of the mensuration window. For more insight on this, we chatted to sex educator Eli Scriver.
“TSS can develop in multiple ways outside of menstruation; tampons are just a particularly commonplace health item that is important to provide broad education about. When TSS cases were much higher, they tended to be caused by high-absorbency tampons, which are not sold anymore, so the risk of developing TSS from tampons are much lower, and almost nil if the tampon is used and replaced regularly.”
What Bacteria Causes Toxic Shock Syndrome?
TSS is sort of like a tampon allergic reaction (if a case is mild, that is). To better understand the actual bacterias that cause this condition, we looked to Dr. Boyer for deeper insight. “Tampons kept inside for a long time frame will trap Staphylococcus aureas bacteria and menstrual blood. The trapped menstrual blood promotes growth of the bacterias by providing a moist environment which is conducive for bacterial growth, multiplication, and development.”
Dr. Boyer goes on to explain that the increase of these bacterias will lead to higher intoxication levels, that may then lead to TSS if the bacterias find their way into the body through vaginal walls.
What does Toxic Shock Syndrome Feel Like?
If you’ve never found yourself Google searching “how to know if you have toxic shock syndrome” in a panicked frenzy, count yourself lucky. A lot of people experience false alarms with this condition when they develop UTIs during their cycle, or something similar.
Firstly, you won’t know that you have TSS from a feeling in the vagina itself. Remember, the condition occurs when the bacteria has seeped its way into the body through the vaginal walls, so the vagina itself is not where the infection is located.
If you start to develop TSS, you’ll likely start to feel sunstroke-like symptoms which will slowly progress into more severe manifestations. High temperatures, flu-like symptoms (headaches, exhaustion, fever), body aches and even throat pains and coughs can come from the onset of TSS. Dr. Erum, who we heard from earlier on, lists some of the more severe symptoms as “sunburn like rash, low blood pressure, and potentially end organ damage or failure.”
If you’re ever worried that you may be at risk of this condition, you can always take an online “do I have TSS” quiz.
How is Toxic Shock Syndrome Diagnosed?
TSS disease needs to be diagnosed by a healthcare professional, and is not something that anyone should self-diagnose based on things they have seen and heard online. Diagnosing TSS is actually not all that simple a process, as there is no single test that can confirm if this is what the body is currently dealing with or not.
One would need to provide both blood and urine samples for the purpose of strep testing. The vagina, throat, and cervix will also be swabbed and tested in order to isolate the common bacterial strain. This can only be done under close lab analysis.
Can Toxic Shock Syndrome Kill You?
It can, and every so often you may come across an article in the news about a toxic shock syndrome death that occurred unexpectedly (or often after music festivals where people tend to forget to change their menstrual products often enough).
The good news is that TSS is totally treatable, if it is caught early and taken seriously. There are a lot of people who ignore the warning signs and choose not to take action, resting in their body’s ability to fight off the infection naturally. Unfortunately with TSS this is rarely possible, and progression is pretty much inevitable if left untreated.
Toxic Shock Syndrome Death Rate
One of the most shocking toxic shock syndrome statistics is that of the death rate. While the actual chances of getting TSS are incredibly low, the chances of death are absurdly high. It is estimated that TSS has a mortality rate that jumps between 30% to 70%, depending on different parts of the world and the quality of healthcare in specific regions.
That said, the above statistic is based on streptococcal TSS. Individuals who catch TSS from S. aureus early enough, are only facing a 5% to 15% chance of dying at the hand of the condition.
Toxic Shock Syndrome from Tampons
It’s important to separate TSS from tampons, as the condition itself is a result of bacteria, and not from a tampon per se. Many remark that TSS is a form of tampon poisoning, but this would put too much power in the hands of tampon-makers, and disempower the natural habitat of the body in which these bacteria can grow, multiply, and spread.
Dr. Clara Lawson spoke further on this issue and cleared up some of the confusion. “To put it briefly, the bacterium Staphylococcus aureus is responsible for causing TSS and not tampons; however, tampons can increase the risk. Tampons that are kept inside the vagina for a long time develop an ideal environment for the bacteria to over-grow and release the toxins in the bloodstream that cause TSS. Usually, Staphylococcus aureus is harmless and present in the vagina. But once overgrown, this bacterium can get into the bloodstream from where it leads to TSS.”
Can Pads Cause TSS?
So if TSS is not always the result of tampons, it begs the question: can you get TSS from wearing a pad too long?
If you were to ask “can you get toxic shock syndrome from a pad”, the answer would be no. However if you were to ask “can you get toxic shock syndrome while wearing a pad”, the answer would be absolutely. The key is not the pad itself, it’s simply that TSS can occur at any point, and the products involved are not important. Because tampons live inside of the vagina, they simply increase the risk of this condition, while a pad would have no impact on one’s risk levels.
How do You Get TSS From Tampons
By now it’s clear that although tampons are never always to blame for TSS, keeping one in for longer than advised only works to increase your risk of experiencing this condition. Yes, you can trigger TSS by keeping a tampon in long past its expiry date, which is what we made reference to earlier in the context of music festivals. This is a great example of where menstrual hygiene is neglected, due to the difficulty in timekeeping and general lack of cleanliness these environments promote.
According to Dr. Lawson, it is therefore strictly advised to use tampons that are made up of cotton or rayon fibers and make sure you are changing them frequently. “Not only in tampons, whatever you use during menstruation, do not overuse it and change it after every 3-5 hours.”
Toxic Shock Syndrome from Tampon
Many would have us believe that super absorbent tampons toxic shock syndrome was the most common form of this condition. Few talk about the notion of pulling out a dry tampon TSS!
Some studies have concluded that one way for TSS bacteria to become introduced into the bloodstream is when one attempts to pull out a tampon that is too dry. This may be because one has allocated the wrong size tampon for the relevant flow-state.
Tiny moisture droplets in the vagina at this time can trigger TSS bacteria into growth. It is thus also important to adjust your tampon size to your different levels of flow.
Why do Tampons Cause TSS?
Long story short, tampons can cause TSS to become a higher risk because they are interfering with the bacterial integrity of the vaginal canal. This is a natural ecosystem that works in balance with the body, so when foreign objects are added to the mix, there is always going to be a risk of imbalance.
Tampons are not “clean” beauty items, no matter how physically clean they are when they are inserted. They contain all kinds of chemicals and bleaches that keep them uniform and white, so it makes sense that some vaginal ecosystems would be more sensitive to their presence than others.
Whenever we make the decision to insert something physical into the human body, we are accepting that there are risks involved. It can’t be otherwise. These are unnatural objects cohabiting in a very natural environment, so there is never a guarantee that nothing is going to go wrong. Anyone who tries to tell you otherwise has a hidden agenda and you should jump at the red flag!
How Long Does it Take to Get TSS if You Leave a Tampon in?
Firstly, just because you fell asleep with yesterday’s tampon in and 14 hours have passed, doesn’t mean that you now have TSS. This is not an exact science, and there have been people who have developed TSS after 8 hours of wear, and those who have developed it with 0 hours of wear (no tampon needed!).
Typically, if your body has started to absorb some of the toxins, it can take between 3 to 5 days before a full onset of symptoms are present. In rare conditions, a person may go from 0 to 100 in a matter of hours, but this would be an extreme case and a severe one at that.
Toxic Shock Syndrome vs Septic Shock
Once one has their toxic shock syndrome diagnosis, health care providers will start to be on the lookout for what is known as “septic shock”. This is sort of where the condition levels up, and induces a dangerous autoimmune response to the infection in which one’s blood pressure will drop too low.
When this happens, a patient is in dire state and at risk of mortality. TSS, however, is not the only condition that can induce a septic shock state. Other vaginal infections such as candida or viruses can bring on this immune response, although the odds are a lot lower.
Toxic Shock Syndrome Symptoms
We touched on some of the TSS symptoms earlier, but for education sake we’ll give you a full breakdown of everything that is possible to experience when this condition is unfolding. Use these as TSS signs when monitoring yourself or your friends!
TSS generally starts out with a high temperature being present in the body. Thereafter, symptoms will progress into flu territory, bringing in sore throat, cough, fatigue, body aches, and chills. One may start to feel physically ill and even vomit, or the condition will go the other direction and try to exit the body through diarrhea.
A toxic shock syndrome rash is very common, and it looks like sunburn all over the body. This is because the skin is your biggest organ, and with this level of toxicity attacking the body, the skin tries to push it out in order to save your life. It’s not uncommon for the tongue, lips and eyelids to turn bright red when suffering from TSS.
Dizziness and the tendency to faint is typical when battling this condition. Patients will find it difficult to stand up or walk unattended. Confusion of mind is also to be expected, and one may struggle to comprehend what is happening, or even who or where they are.
How Soon do Toxic Shock Syndrome Symptoms Appear?
The early signs of toxic shock syndrome can appear around 12 hours after the inset of the bacteria, but it sometimes takes 3 to 5 days before a person starts to register them as abnormal. This is because one usually doesn’t feel a sore throat and think “this must be vagina related”. The symptoms are easy to brush off as something more common, and so most people only realize what they are dealing with once the condition enters dangerous territory.
How Long does it Take to Get TSS Symptoms?
The appearance of symptoms related to TSS has little to do with how or why the condition itself has been able to manifest. Some may think that Tampax TSS, for example, may bring about faster symptoms than a competitor brand, but this would be a totally illogical way of understanding this disease.
TSS symptoms have nothing to do with what triggered the onset of the condition, and everything to do with the existing state of the immune system of the individual in question. Someone with a weak immune system will likely start to experience more severe symptoms soon after the onset of the bacteria into the body, whereas someone with a strong immune system could ride it out in a mild way for days before succumbing to the toxic attack.
There is no standard time frame for TSS: it is a different experience for everyone. Age may also be a contributing factor to the timing of symptoms.
How Long does it Take to Get Toxic Shock Syndrome from a Tampon?
We’d like to reiterate that TSS is a medical emergency, and it is not a condition that can simply go away on its own. If you’re wondering how long does toxic shock syndrome last, it’s better to consider this in relation to how long it takes an individual to seek help at the first sign of symptoms.
Toxic Shock Syndrome Treatment
Does TSS go away? It absolutely can. If caught and treated in a timely fashion, TSS can be easily cured and one can return to normal life very soon after. Hospitalization is almost always necessary when dealing with TSS, no matter how mild. This is because of the condition’s tendency to mutate rapidly, and a patient can go from a medical safe zone to right outside death’s door within a matter of hours.
In short, TSS is always treated by medical professionals, and is not a condition where alternative medicines/holistic medicines are currently being explored. It’s too quick and too dangerous for medicinal alternatives to be carried out at this time.
How to Treat Toxic Shock Syndrome
There are a number of ways that TSS may be treated by a health care provider. Antibiotics are the most common, as this is a bacterial infection and thus it tends to respond to eradication. Toxic shock syndrome antibiotics have to be administered through a drip, as opposed to taken orally.
The shock that this condition inflicts on the body is immense, so fluids are usually administered also via drips in order to reduce the tissue damage and prevent further organ strain. When a patient is exhibiting very low blood pressure, heart medications will usually be added to the mix.
Patients whose TSS results in kidney failure will be placed on dialysis. Surgical wound healing may be required in some cases, and oxygen may be supplied to aid breathing while the patient is being treated.
Toxic Shock Syndrome Stories
Some toxic shock syndrome cases are worse than others, and one can read endless horror stories online. We spoke with TSS survivor, Melisa Clement, who shared her experience of this horrific condition. Toward the end of her monthly cycle, Melisa was attending a major event and had to wear all white. To avoid surprises, she made the decision to use a super jumbo tampon (even though it was not necessary).
She attended her event and left the tampon in overnight, knowing it was big enough to last that long. Enjoying the ease of the maintenance, she inserted another of the same the following day and left it in for longer than recommended. “By the next evening (3 days later from the original event day), I was suddenly very sick. Like 104 temp, vomiting sick. It was flu season, so I thought it was the flu and I’d just sleep it off.”
That didn’t help, and Melisa finally made her way to a doctor a few days later, only they too couldn’t isolate anything inherently wrong with her, and speculated that the dizziness and burning in her hands and feet was the onset of of rheumatoid arthritis or another auto-immune disorder. They did blood work and found nothing.
Melisa was sent home and sought help from an alternative healer, who was able to bring relief and her symptoms cleared up. However, a week later, they were back and more severe. Melisa found bubbles forming under the skin of her fingers and toes, and soon all of her skin started to peel off in large sheets. “It was crazy. At that point, I decided to google hands and
feet peeling, high fever, vomiting and what do you know, the first thing that came up was Toxic Shock. I realized completely how everything then just made sense and fell into place.”
Melisa was one of those rare statistics that developed this condition not only from leaving a tampon in too long, but rather from using one that is too absorbent for your current flow state.
“I’m here to tell you that it definitely happens, and it’s all because we don’t know any better, and assume that bigger is better when it comes to tampons!” says Melisa.
After Effects of Toxic Shock Syndrome
Most patients make a full recovery after TSS, and are very quickly back to their old routines. However, there is little known about the long term side effects that TSS can leave behind, even when a person has technically recovered back to health.
Some survivors report persistent muscle weakness, and others maintain that there is psychological damage that plays out for years following recovery. This includes loss of memory, difficulty concentrating, and increased emotional responses that were not in place prior to the condition.
How to Prevent Toxic Shock Syndrome
Prevention of toxic shock syndrome is possible if you want to lower your risk due to the presence of tampons. Unfortunately, there is no one on earth who can 100% guarantee that they will never develop Toxic Shock Syndrome, even if they never touch a tampon in their lifetime. As we now know, this is a bacterial phenomenon, and there is little one can do to control a bacterial environment at all times within the body.
How to avoid tampons and toxic shock syndrome? Well, you can simply start by vowing to change your tampon more regularly than you might like. Changing at least every 4 hours cuts the risk factor significantly, but it can be an incredibly annoying thing to do for days at a time.
Naturally, avoid using super-absorbent tampons. Most of these commercial brands are banned from sale worldwide, but you may find some brands that are making DIY renditions and putting people at risk.
Never use tampons that have been laying around without a wrapping on them. This is a major no-no, and fishing out a loose tampon from your makeup bag or toiletry cupboard is asking for trouble. Always use individually wrapped tampons and only unwrap just before you insert!
Always wash your hands properly before inserting a tampon. This is another important point, as bacteria is easily transported by fingers and we simply have no way of knowing what we are carrying around at any given moment.
Finally, Lori, Jodi and Kari Caden, sisters and co-founders of leakproof period underwear brand, Proof, gives us a top tip for significantly improving one’s odds against this treacherous condition. “My top safety tip to eliminate the risk of TSS would be switching to tampon alternatives such as leak proof period underwear by Proof. These provide hours of leakproof protection without the risk of TSS or harmful chemicals sprayed other period panty brands (every pair of Proof undies is tested for PFOA/PFAS, lead and phthalates, and is Prop 65 compliant).”
There you have it, folks!
Best Tampons to Avoid TSS
The following tampon types would be the best choices when looking to avoid increased risk of tampons and toxic shock syndrome:
Using the smallest tampons you can find, and changing them every 4 hours, is a sure way of reducing your risk of exposure to TSS causing bacteria. Even if you have a super heavy flow, using small tampons more frequently is far better than inserting one super sized one and letting it sit for 10 hours.
It may be inconvenient, but it could save your life.
Organic tampons are made free from chemicals and artificial toxins, which means they are a healthier and cleaner solution to menstrual products. They are typically made of 100% pure cotton, unlike regular ones that are usually made with rayon.
Organic tampons are bleached with peroxide, which actually has antibacterial properties. While regular tampons are bleached with chlorine — the stuff that eats away whatever it comes into contact with.
You can also opt for bleach-free tampons, in rayon or cotton. This means that no peroxide or chlorine have been used to give the tampons that crisp white appearance, and you may have a visually less appealing tool, but increased safety as a result.
There are new tampon models on the market, and the ones we are referring to here are essentially tampon sponges. These are small oval-shaped sponges that are doused in an applicator gel for easy insertion, hence the wet label.
Once inside, these tampon sponges settle in and absorb your flow, and there is no need to change them before the 8 hour mark is reached. They have naturally less risk of TSS and even if you need to remove the sponge having not bled, it will not release the moisture that a dry tampon would and put you at risk of toxic infection.