Toxic Shock Syndrome (TSS)

 by Bianka Anszczak

We have all seen a tampon commercial at some point in our lives; girls laughing, running on the beach talking about how great they feel, but rarely any of us read the fine print which says that it can cause a rare but nonetheless fatal disease, Toxic Shock Syndrome (TSS). 

TSS can have a very sudden onset and can appear out of the blue. When it does things get really bad, really quickly. Symptoms include high fever, rash, low blood pressure and flu/ cold like symptoms, before long you will succumb to multiple organ failure. Making this disease difficult to spot before it is too late. It is almost like something out of a horror film.

Of course, this disease is not actually caused by the tampons themselves, but by 2 culprits; one called Staph’, (Staphylococcus aureus) the other ‘Strep’ (Streptococcus pyogenes). But tampons are what provide the perfect environment for them to grow. 

The fact is, TSS has nothing to do with menstruation. These bacteria can be found on almost everyone. And so, whilst TSS may be rare (estimated to affect 3-6 people per 100,000 per year) the bacteria itself is not. Typically found on the skin, they are usually harmless. They may cause minor infections (such as Strep throat), but these sorts of infections are easily treated with a short round of antibiotics. So why is it that with the flip of a switch they can go from causing mild illness to potentially killing you with TSS?

As mentioned earlier, the majority of this bacteria is living harmlessly on our skin. They are harmless because not all of them are able to produce toxins called superantigens (and even if they do, then they are not switched on and not produced all the time). An antigen is foreign substance that can enter the body. They are normally easily recognised by the immune system and killed by good cells, such as T-cells. The difference between normal antigens and superantigens is to do with how many of these T-cells respond to them appearing in the body. Whereas normal antigens might simulate about a 0.01-0.1% of the T-cells to respond, superantigens activate 5-30%. This causes the immune system to go into overdrive and start turning on its own body cells and tissues, damaging and killing them.

It has been found that it is the environment in which the bacteria are living that determines whether the genes (which code for these superantigens) are turned on or off.

Hence why, over ½ of Staph related cases are associated with tampon use. Tampons provide a warm, moist environment for the bacteria to grow in which is why it is important to change a tampon every 4-8 hours; that is not to say that changing it before 4 hours or after 8 will dramatically decrease or increase your risk of infection (but the general rule is, the longer it is left in, the longer bacteria has time to multiply). Other factors are also at play such as the tampon being super absorbent. This can cause dryness and allow toxins easier access to the bloodstream. Moreover, the tampon can also introduce oxygen, both of which change the environmental conditions for the bacteria, enabling them to switch on their genes and produce superantigens. 

Now tampons of course are not the only thing that can increase the risk of developing TSS. Things such as surgery, childbirth, open wounds from cuts, bites and picking at your skin all play a role. Although this disease is rare, the effects it can have can be detrimental to a person's life (even if you are able to escape death, the bacteria can still lead to having amputations, brain damage or permanent blindness). Hence why it is so important to be educated about the potential risks and know how to minimise them where possible. 

For that, the answer is simple. Here are some basic rules of thumb you should abide by:

1. Wash your hands (especially under your nails!)
2. Use tampons correctly!

With antibiotic resistance on the rise, Staph and Strep are the last thing you want.