The Wisconsin Department of Health Services has received five reports of Toxic Shock Syndrome since July 2022. Four of the five cases are associated with super-absorbent tampon use in teenage girls, who may be more likely to leave tampons in for prolonged periods of time. No deaths have been reported.
“This is a remarkable trend. Most years Toxic Shock Syndrome (TSS) has been zero or one case per year in the last decade,” said Dr. Ted Miller, an SSM Health obstetrician and gynecologist, in a recent radio interview. "It peaked back in 1980 when there were 10 cases per 100-thousand people."
TSS is a serious illness most often caused by Staph aureus and sometimes caused by Strep pyogenes, both of which produce toxins. Dr. Miller says half of all cases are linked to menstruation, but this syndrome can also result from infected wounds from surgery, kitchen injuries or even working in the yard.
History of Toxic Shock Syndrome
In the 1970’s, Proctor and Gamble introduced the Rely tampon using compressed polymer technology, which was reportedly able to absorb 20 times its weight in liquid. The goal was to prevent leakage. Women found these to be so effective that they were able to leave these tampons in for hours, and sometimes all day long.
“Then, in January of 1980, Dr. Jeff Davis, the chief medical officer for communicable diseases and an epidemiologist for the state of Wisconsin was the first to recognize the association of TSS in menstruating women,” explains Dr. Miller. “That summer a CDC task force contacted Dr. Davis and investigated the epidemic. In September, the CDC reported their findings that users of Rely tampons were at increased risk of developing TSS compared to all other brands. Proctor and Gamble quickly removed the product from the market. The incidence of TSS fell rapidly, due to both the removal of the synthetic Rely product as well as greater public awareness of the disease.”
So, why is there an uptick in cases right now?
With so few cases of TSS over the years, many are wondering why there was a sudden uptick in the last eight months.
“That’s a great question,” said Dr. Miller. “Maybe after a decade, young women have forgotten or haven’t been told about what happened 40 years ago. Young women are the most vulnerable. They’re also the ones who tend to use the super-absorbent tampons the longest.
Know the Symptoms
Symptoms of TSS are high fever, a sunburn like rash, nausea, muscle aches and confusion. Skin peeling occurs later, particularly involving the palms of the hands and the soles of the feet. If not treated quickly, this can rapidly progress to coma, multiple organ failure and death.
“Most are treated and recover in two weeks. Some are fatal within hours,” says Dr. Miller. “Treatment is aggressive administration of intravenous fluids, blood pressure support in the ICU, intravenous antibiotics, and most importantly drainage or removal of the source of infection. All of these things must occur immediately.”
Prevention is Key
How do you prevent TSS? We have several recommendations.
- Use pads at night rather than tampons
- Change tampons every 4 to 6 hours
- Keep open wounds clean, and report to your physician any signs of infection such as tenderness, spreading redness or drainage with puss in it
- Wash your hands frequently to minimize the risk of infection
Millions of women use cotton-containing tampons daily, and if used properly they are very safe.
