What are the dangers and how does toxic shock syndrome manifest when using tampons? Toxic shock syndrome: causes and signs of the condition. Why is it dangerous? Staphylococcal shock

Other names: infectious-toxic shock

Toxic shock syndrome (TSS) is a rare but serious infectious disease, most often caused by the bacterium “staphylococcus” (Staphylococcus). This bacterium is present in people in the mucous membrane: nose, throat, vagina, perineum.

In most cases, this bacterium is not dangerous. But in people with low immunity, bacteria can multiply, causing infection and spreading toxins. These toxins enter the bloodstream and attack various organs: the liver, kidneys and lungs.

The infection is similar to the flu and in rare cases can lead to death.

Causes

The main cause of toxic shock syndrome is the use of vaginal tampons or menstrual cups for too long a period (more than 4-6 hours).

During menstruation, the pH of the vagina changes. It becomes alkaline (less acidic). This medium provides a favorable culture medium for Staphylococcus aureus. So, if blood sits in the vagina for too long, bacteria can develop and cause an infection.

TSS came to public attention in 1980, when more than 700 women were infected in North America.

Toxic shock syndrome is not always associated with tampon use and can occur after surgery or accidental injury.

Symptoms

Symptoms of toxic shock syndrome appear suddenly:

Confusion, dizziness.
Severe fatigue, weakness.
High temperature between 39°C and 40.5°C.
Headache.
Redness of the eyes, vagina.
Acute diarrhea, vomiting.
A sore throat.
Extensive rash accompanied by redness.

At the primary stage of infection, symptoms resemble flu (pain in muscles, joints, throat, fever). Then red rashes appear. Added to this is indigestion (diarrhea, vomiting). Only after this shock is manifested by low blood pressure, tachycardia, and confusion. After 1-2 weeks, the skin begins to peel off, especially on the palms and soles of the feet.

Diagnostics

Diagnosis of TSS requires a clinical examination. Blood or tissue tests may be performed to look for microorganisms. Other tests may be performed, such as an electrocardiogram, x-ray, computed tomography scan, or magnetic resonance imaging (MRI).

Treatment

If these symptoms occur, your first instinct is to remove your tampon or menstrual cup.

Second reflex: go to the hospital.

People suffering from toxic shock syndrome require intensive care. Treatment consists of oral and intravenous therapy to maintain blood pressure.

Wounds and all sources of infection are washed with water and thoroughly cleaned. Antibiotics are given intravenously to reduce the risk of recurrent infection.

Prevention

Fortunately, toxic shock syndrome is less common now than it was in the 1980s, with the most dangerous tampon models being removed from the market. The following measures also help women reduce their risk of developing toxic shock syndrome:

During heavy periods, alternate using tampons and pads.
Change tampons and pads every 4-6 hours.
Maintain good general hygiene, especially in the vaginal area.
Use a pad at night.

Infectious-toxic shock is a nonspecific pathological condition caused by the influence of bacteria and the toxins they secrete. This process can be accompanied by various disorders - metabolic, neuroregulatory and hemodynamic. This condition of the human body is an emergency and requires immediate treatment. The disease can affect absolutely anyone, regardless of gender and age group. In the international classification of diseases (ICD 10), toxic shock syndrome has its own code - A48.3.

The cause of this disease is severe infectious processes. Infectious-toxic shock in children is very often formed on the basis. The development of such a syndrome depends entirely on the causative agent of this disease, the state of the person’s immune system, the presence or absence of drug therapy, and the intensity of exposure to the bacterium.

The characteristic symptoms of the disease are a combination of signs of acute circulatory failure and a massive inflammatory process. Often the external expression develops quite quickly, especially in the first few days of progression of the underlying disease. The very first symptom is severe chills. A little later, increased sweating, intense headaches, convulsions, and episodes of loss of consciousness appear. In children, this syndrome manifests itself somewhat differently - frequent vomiting that has nothing to do with eating, diarrhea and a gradual increase in pain.

Diagnosis of infectious-toxic shock consists of detecting the pathogen in the patient's blood tests. Treatment of the disease is based on the use of medications and special solutions. Since this syndrome is a very serious condition, before the patient enters a medical facility, he must be given first aid. The prognosis of toxic shock syndrome is relatively favorable and depends on timely diagnosis and effective treatment tactics. However, the chance of death is forty percent.

Etiology

The reasons for the progression of this condition are the combination of an acute infectious process and weakened human immunity. This syndrome is a common complication of the following diseases:

pneumonia (of any nature);

Other nonspecific factors in the development of infectious-toxic shock in children and adults are:

surgical intervention;
any violation of the integrity of the skin;
pathological labor activity;
complicated abortion;
allergic reactions;
or ;
substance abuse.

Another reason for this condition is the use of sanitary tampons by female representatives. This is due to the fact that when using such an item during menstruation, it can penetrate into the female body, which produces dangerous toxins. The disease often affects girls and women aged fifteen to thirty years. The mortality rate in this case is sixteen percent. In addition, there have been recorded cases of the occurrence of such a disorder due to the use of vaginal contraceptives.

The pathogenesis of infectious-toxic shock is the entry of a large amount of toxic substances into the circulatory system. This process entails the release of biologically active substances, which leads to disruption of blood circulation.

Varieties

There is a classification of toxic shock syndrome depending on the degree of its development. This division is based on the severity of symptoms. Thus, we distinguish:

initial degree- in which blood pressure remains unchanged, but heart rate increases. It can reach one hundred and twenty beats per minute;
moderate severity– characterized by progression of symptoms from the cardiovascular system. Accompanied by a decrease in systolic blood pressure and increased heart rate;
severe degree– a significant drop in systolic tone (pressure reaches seventy millimeters of mercury). The shock index increases. Fever and a decrease in the volume of urine emitted are often observed;
complicated stage– characterized by the development of irreversible changes in internal organs and tissues. The patient's skin takes on an earthy tint. A comatose state is often observed.

Depending on the pathogen, there are:

streptococcal syndrome– occurs after childbirth, infection of wounds, cuts or burns of the skin, and is also a complication after infectious disorders, in particular pneumonia;
staphylococcal toxic shock– often develops after surgery and the use of hygienic tampons;
bacterial toxic shock– occurs for a reason and can complicate any stage of sepsis.

Symptoms

Symptoms of toxic shock are characterized by rapid onset and intensification. The main features are:

decrease in blood pressure, heart rate increases;
sudden increase in body temperature, even fever;
intense headaches;
bouts of vomiting that are not associated with food intake;
diarrhea;
stomach cramps;
severe muscle pain;
dizziness;
seizures;
episodes of short-term loss of consciousness;
tissue death - only in cases of infection due to a violation of the integrity of the skin.

In addition, there is a development of, and. A similar syndrome in young children is expressed by stronger signs of intoxication and constant jumps in blood pressure and pulse. Toxic shock syndrome from tampons is expressed by similar symptoms, which are accompanied by a rash on the skin of the feet and palms.

Complications

Quite often, people mistake the above symptoms for a cold or infection, which is why they are in no hurry to seek help from specialists. Without timely diagnosis and treatment, a number of irreversible complications of infectious-toxic shock may develop:

impaired blood circulation, causing internal organs to not receive the proper amount of oxygen;
acute respiratory failure – formed due to severe damage to the lungs, especially if the syndrome was provoked by pneumonia;
impaired blood clotting and increased likelihood of blood clots, which can cause excessive hemorrhage;
renal failure or complete failure of the functioning of this organ. In such cases, treatment will consist of lifelong dialysis or transplant surgery.

Untimely emergency care and improper therapy lead to the death of the patient within two days after the expression of the first symptoms.

Diagnostics

Diagnostic measures for toxic shock syndrome are aimed at detecting the causative agent of the disease. Before performing laboratory and instrumental examinations of the patient, the doctor must carefully study the person’s medical history, determine the intensity of symptoms, and also conduct an examination. If the cause of this condition is the use of tampons, then patients are required to be examined by a gynecologist.

Other diagnostic methods include:

conducting general and biochemical blood tests is the main way to identify the pathogen;
measuring the amount of urine emitted per day - with such an illness, the volume of daily urine will be much less than that of a healthy person;
instrumental examinations, which include CT, MRI, ultrasound, ECG, etc. - aimed at determining the extent of damage to internal organs.

An experienced specialist can easily determine infectious-toxic shock by the patient’s appearance.

Treatment

Before carrying out therapy in a medical facility, it is necessary to provide the patient with emergency first aid. Such events consist of several stages, which include:

ridding the victim of narrow and tight clothing;
ensuring a horizontal position so that the head is slightly elevated in relation to the entire body;
You need to put a heating pad under your feet;
allow fresh air to flow in.

These actions are limited to emergency care, which is not performed by a specialist.

After transporting the patient to a medical facility, intensive treatment of infectious-toxic shock with medications begins. Often, hormonal substances, antibiotics and glucocorticoids are used to actively destroy bacteria. The use of medications is individual and depends on the causative agent of the disease.

If the infection occurs due to the use of tampons or vaginal contraceptives, then treatment is to immediately remove them from the body. This may require curettage, and the cavity is treated with antiseptic drugs.

Prevention

Preventive measures against toxic shock syndrome consist of following several rules:

timely elimination of diseases that may cause the development of such a condition. In most cases in children and adults it is pneumonia;
always ensure the cleanliness of the skin, and if any damage to the integrity occurs, immediately treat the affected area with antiseptic substances;
take breaks from using tampons during menstruation. Alternate pads and tampons every two menstruation, and also change such hygiene products in a timely manner.

The prognosis of the disease will be favorable only if first aid is provided in a timely manner, the cause of this condition is identified, and drug treatment is started.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

Most of the diseases familiar to humanity have a history of thousands of years. These ailments have been well studied, and for many of them, appropriate diagnostic and therapeutic methods have been developed. But some problems, having no less ancient “traditions,” acquired their modern name quite recently. Toxic shock syndrome is one of them. Moreover, the problem is not a common one, so doctors’ awareness of this issue leaves much to be desired. Therefore, we felt that a separate and detailed conversation about toxic shock syndrome would not only be educational, but also have a very practical meaning.

Historical background and gender

It all started with the fact that in 1978-1979, scientists drew attention to too many young women under the age of 17 who sought medical help with the same complaints (more about them below), which could not be “fitted” into any one disease known to science. By 1980, about 700 such cases had been reported in the United States alone, and there was no clear picture of what was happening. But as you know, water wears away stone, so by 1981, scientists found out that almost all those who got sick used super-absorbent hygienic tampons, which were fashionable at that time. This is how toxic shock syndrome was actually “discovered”. As a result, the manufacturers of this hygiene product quietly, but very quickly, withdrew the products from stores, after which the incidence rate sharply declined.

But if you decide that representatives of the stronger half of humanity can breathe a sigh of relief and once again congratulate themselves on being male, then you are deeply mistaken. In approximately 15% of registered cases, the disease affects them, so it cannot be called exclusively female. There is also no need to say that refusing tampons guarantees immunity in this case, since a small number of patients used other hygiene products or, due to their age, did not use them at all.

To complete the picture, it is also necessary to clarify the question of the connection between the syndrome in question and “ordinary” toxic shock, which has been known for quite some time. Confusion often arises here, but it would be a mistake to equate these pathologies. And with similar symptoms, these are, nevertheless, completely different diseases that require different diagnostics and treatment.

Risk factors

Toxic shock syndrome, as we have already found out, is a “young” disease, therefore there is still no consensus among doctors about what can serve as prerequisites for its development. It has already been clarified that tampons alone cannot be “blamed”: men do not use them, just like women during menopause. What risk factors are now considered the most likely?

The main (and, in a good way, the only) suspects are group A streptococcus (Streptococcus pyogenes) or staphylococcus (Staphylococcus aureus). They produce special toxins, which serves as a trigger for the development of the syndrome. But there are more reasons for infection with these microorganisms:

Hygiene products. The problem may lie either in them (elementary defects, use of low-quality materials, non-compliance with technology), or in a banal neglect of cleanliness.
A special diaphragm (or vaginal tube) used to prevent unwanted pregnancy.
Damage to exposed skin as a result of a burn, mechanical injury or cut.
Surgery on the pelvic organs or childbirth.
Some infectious diseases (colds, flu, chickenpox).

The question of how streptococcal and staphylococcal types of toxic shock syndrome differ is a little more complicated. It is believed that the first option is somewhat more gentle, since with it the damage to the skin (and, as a result, the severity of the manifestations) is not so significant. The staphylococcal species, on the contrary, has serious clinical symptoms and, accordingly, is more difficult to treat.

Symptoms and pathogenesis

Before moving on to a consideration of clinical manifestations, it is necessary to understand in general terms how the disease proceeds. It is believed that most clinical manifestations are explained not so much by the infectious pathogen as by the immune response to it. In this case, there is a direct relationship between the severity of symptoms and the concentration of specific antibodies in the blood. Consequently, if their levels are reduced in children and adolescents, the course of the disease will be more severe. The clinical manifestations themselves may be as follows:

Recognizing toxic shock syndrome and differentiating it from other pathologies is quite difficult. The most obvious and simple way is to analyze the time of onset of symptoms.

Streptococcal nonmenstrual syndrome:

2-3 days (but not more than 2 weeks) after birth;
from 2 to 7 days after any surgical intervention or traumatic medical procedure;
2-6 weeks from the first respiratory symptoms.

Staphylococcal menstrual syndrome:

3-5 days after the start of menstruation.

Staphylococcal nonmenstrual syndrome:

12 hours after surgery (if special dressings were used, which often happens with rhinoplasty).

Diagnostics

Therapeutic measures

Toxic shock syndrome is not a death sentence. And with timely measures taken, it responds well to treatment. But in this case, the word “timely” should be taken literally, since if the preliminary diagnosis turns out to be correct, the patient has practically no time. In other words, this disease requires immediate (!) hospitalization, and resuscitation measures should begin while still in the ambulance. And self-medication, beloved by our citizens, is a dead-end path that can easily lead to death. How can the hospital help the patient?

Elimination of the source of infection.
Thorough surgical treatment of the wound.
Normalization of blood pressure.
Compensation for large fluid loss, which is often observed with vomiting or severe diarrhea.
Targeted treatment with antibiotics (clindamycin, cloxacillin, cefazolin, vancomycin, linezolid, daptomycin, tigecycline).
Intravenous administration of immunoglobulin or its derivatives.
Activities aimed at removing toxins from the body.
In extreme cases - surgical excision of the affected tissue.

Prognosis and possible complications

With timely and sufficient therapy, in most cases patients recover completely in 10-15 days. If we talk about possible risks, then the situation depends entirely on the type of syndrome. With the streptococcal form, the probability of death is 50:50, in the case of staphylococcal - about 5%.

Why is the syndrome dangerous?

complicated sepsis;
necrotizing fasciitis;
liver failure (yellowness of the skin, abdominal pain, nausea, disorientation, vomiting);
renal failure (weakness, muscle cramps, itching, chest pain, high blood pressure, swelling, problems with urination);
heart failure (rapid pulse, cough, wheezing, chest pain, loss of appetite, shortness of breath).

Prevention

refusal after childbirth from barrier methods of preventing pregnancy for 3-4 months;
follow the instructions of the manufacturer of hygiene/contraceptive products as closely as possible. This primarily applies to diaphragms, cups and IUDs. So, if it is recommended to change tampons every 8 hours, you should not “save” and stretch it out over a day;
Thorough treatment of any cuts, abrasions and burns. The same applies equally to insect or animal bites.
regular visits to the clinic if you have recently had surgery;
control over children with chickenpox (you can’t scratch the sores!);
compliance with basic rules of personal hygiene;
during pregnancy or immediately after childbirth, minimizing contact with people with sore throat.

Conclusion

Toxic shock syndrome is a rare but extremely dangerous disease. However, with timely (!) diagnosis, qualified therapy and careful adherence to all medical recommendations, it can be treated well. It is important to understand that in this case the difference between “treatment” and “self-medication” is most noticeable. And it seems to us that risking your health and life for the sake of time “saved” on a visit to the doctor is not a good idea. Be healthy!

Toxic shock syndrome during menstruation was documented back in the 1980s, but is now largely forgotten. Women are sounding the alarm: deaths have increased again.

Some researchers believe that toxic shock syndrome from tampon use is at its peak. Despite warnings from manufacturers, many girls do not pay attention to the labels on the packages and violate the rules for using tampons. But trouble comes not only from ignorance. Some girls are so intimidated by their peers and certain ladies from anonymous women's forums that they are convinced that tampons cannot be used, since they only cause harm and can even lead to death.

Both are two extremes that should be avoided.

Toxic shock syndrome (TSS) from tampons. What is this?

You might have heard this in the context of the latest horror stories about tampons. Toxic shock syndrome (or infectious-toxic shock) is a shock condition caused by certain bacteria in the body. In the female body, TSS is caused by a strain of staphylococcus. This almost always occurs during menstruation. You probably know that staphylococcus is found in all the mucous membranes of our body in small quantities. If there is a failure, bacteria begin to release toxins that are dangerous to human health. Blood and oxygen are what Staphylococcus aureus needs to reproduce. The main risk factor is the use of tampons.

Outbreaks of toxic shock syndrome cases in menstruating women occurred in the early 1980s. Doctors found that most girls with this diagnosis used tampons. Yes, TSS is a serious illness that can be fatal. The mortality rate is approximately 8-16%. The fact is that the medical community has not yet proven a direct link between toxic shock syndrome and tampons, despite forty years of observation. However, all tampon manufacturers always indicate the likelihood of TSS on their packaging.

Main symptoms of TSS:

Increased body temperature (can rise to forty degrees);
Low blood pressure;
Muscle spasms, possible convulsions;
Hallucinations, foggy consciousness;
Chills;
Nausea and vomiting;
Red spots on the palms and soles of the heels.

You might think these symptoms are similar to having the flu. Remember the main thing: in any case, you must immediately consult a doctor! A patient with symptoms of toxic shock syndrome should be hospitalized immediately because the syndrome progresses very quickly.

I experienced toxic shock syndrome. What should I do?

If you have TSS, your body most likely does not produce enough of the necessary antibodies. If you feel the above symptoms, first of all, remove the tampon. If you use contraceptives that you cannot remove on your own, be sure to warn your doctors about this. As already said, call a doctor, as you need to be hospitalized.

The infected area is cleaned either by vaginal lavage or minor surgery. It depends on the severity of the disease. As a rule, after this initial procedure, patients feel significantly better.
The doctor immediately prescribes antibiotics to kill the toxic bacteria. It is important to note that antibiotics must be taken immediately in order to begin treatment immediately. Antibiotics are taken for two weeks, sometimes less. Most likely you will be prescribed something from this list: clindamycin, cloxacillin or cefazolin.
If you take antibiotics and your condition does not improve, your doctor will prescribe intravenous immunoglobulin. Medicine has not proven the effectiveness of treating toxic shock syndrome with immunoglobulin, but the fact remains that it helps the body produce the necessary antibodies to destroy toxic bacteria.

Patients who seek treatment on time recover within 1-2 days. Remember: self-medication is strictly prohibited!

If you have ever had toxic shock syndrome, then you need to alternate between using tampons and pads. Perhaps there is a reason to use tampons only in exceptional cases, so as not to expose yourself to unnecessary risk. It is also best not to use barrier contraceptives such as a diaphragm, cervical cap, sponge or intrauterine device.

I'm afraid of getting toxic shock syndrome. How to prevent the development of the disease?

Women in labor are at risk. In the first twelve weeks, you should not use tampons or barrier contraceptives!
Before inserting a tampon, be sure to wash your hands thoroughly with soap! This is one of the most important conditions. If you are in a public place where this is not possible, buy hand sanitizer: it kills up to 99.99% of bacteria and is inexpensive.
Never keep a tampon on for more than 8 hours. There are cases when girls wore the same tampon for several days without consequences, but still it’s not worth the risk. It is advisable to use pads at night.
American doctors note that when using super-absorbent tampons, the risk of menstrual toxic shock is very high. Skip them and use tampons with medium absorbency.

Why is it important for a woman to feel comfortable during menstruation?

You know that your period is the most vulnerable time in your life. In addition to constant mood swings, you sometimes (or not sometimes?) experience discomfort or pain in the abdominal area, headaches, and dizziness. You don't feel attractive. You have to comply with certain restrictions, for example, do not swim in open water, do not ride a horse, do not ride a bicycle, and so on. In addition to this, almost everyone has a set of underwear “for these days,” which sometimes further aggravates the depressed state of mind. You cannot afford to wear the underwear you want, as it may cause physical discomfort.

There is a way out of such situations. Your gynecologist will prescribe you suitable painkillers, and a tampon, unlike a pad, will help you feel attractive. Fortunately, humanity took care of this and invented tampons even before our era. It appeared in its familiar form in the first half of the 20th century. A tampon has many advantages.

It is very convenient to use. Since it is located inside the vagina and not outside, the woman does not feel it, unlike a pad.
It does not cause skin irritation.
You can play sports, swim and ride a bike with it.
It fits any shape of underwear.

Millions of women use tampons. Don't panic and give up on them forever. To avoid toxic shock syndrome, just remember the above tips and carefully monitor your health and hygiene during these days.