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Toxic Shock Syndrome: What I’m Telling My Daughter

Arefa Cassoobhoy, MD, MPH - Blogs
By Arefa Cassoobhoy, MD, MPHBoard-certified internistDecember 21, 2017
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Editor’s note: Wasser announced on Monday, Jan. 15, 2018, that her other leg had to be amputated due to Toxic Shock Syndrome.

Original post: 

Toxic Shock Syndrome (TSS) is in the news with model Lauren Wasser’s advocacy work. She lost her leg from TSS and is now raising awareness about this rare risk of tampons.

For those of us who remember the 1980s, we first heard about TSS back when multiple young women got severely sick and even died. Their illness was linked to tampon use, in particular highly absorbent tampons. Since then, polyacrylate rayon products have been removed from the market and the number of women who get TSS during their period has dropped.

But my teenage daughter isn’t aware of that history, and I realize Wasser’s story is something I should share with her as an important learning point. TSS is rare, but it does still occur. She needs to know how to take care of herself.


Lauren Wasser

What is Toxic Shock Syndrome? It’s a severe infection that healthy women can get, and it progresses quickly, as fast as 2 to 3 days after the start of your period. The key symptoms and signs are flu-like: high fevers, feeling faint, a sunburn like rash, vomiting, and diarrhea. If you got it, you’d be hospitalized and closely taken care of because it can go on to affect all organs in the body.

The infection is from toxins produced by certain staphylococcus aureus bacteria. That’s from the same family of staph bacteria you have heard about called MRSA and MSSA. They’re mainly known for causing folliculitis, skin abscesses, and other infections in the body. The bacteria can live in your nose, on your skin, and in your vagina and rectum.

Most people develop antibodies to the TSS toxin in their late teens, and by their 30’s, 90-95% have the antibody. Most people who get sick from TSS don’t have the antibody or enough of the antibody. In a susceptible person, a tampon in the vagina can be the place where the toxin-producing bacteria grows and, in rare cases, progress to TSS.

Today, half the cases of TSS that occur are related to menstruation. The women who get it are more like to have used high absorbency tampons, used tampons continuously for more days of their cycle, and kept single tampons in place for a longer time. Teenage girls and women under 30 are more at risk.

What’s the bottom line?

I’m telling my daughter to feel comfortable using tampons within certain parameters to stay safe and healthy.

  • Wash your hands before putting in or taking out a tampon. Be gentle. The tampon should not irritate or scratch your skin.
  • Change your tampon every 4-6 hours or more often if your flow is heavy.
  • Use the right size tampon. For light flow, use the slender tampons. Avoid the super absorbency tampons.
  • Alternate using tampons during the day with pads at night.
  • Do not use tampons when you’re not on your period.

Toxic shock syndrome is rare, but it’s very dangerous. If you have a high fever, feel faint, get a sunburn-like rash, vomiting, or diarrhea, take your tampon out immediately, and get to a doctor. Let them know you’re on your period and were using a tampon. And then, call mom.

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About the Author
Arefa Cassoobhoy, MD, MPH

Arefa Cassoobhoy, MD, MPH is a board-certified internal medicine doctor and a WebMD Medical Editor. She is on the team that makes sure all WebMD content is medically correct, current and understandable. She sees patients at the Women’s Wellness Clinic at the Atlanta Veterans Affairs Medical Center.

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