Menstrual sts. Infectious-toxic shock: correctly recognize and provide first aid. Classification of shock conditions

Toxic shock syndrome from tampons is the topic of the article. You will learn the cause and symptoms of the disease. And also what threat feminine hygiene products pose. What can replace pads and tampons?

Tampon toxic shock syndrome

Toxic shock syndrome from tampons is a serious disease that manufacturers do not write about on the packaging of feminine hygiene products. Although this pathology is rare, it is progressing more and more every day.

The disease at the first stage resembles the flu, so people begin to treat themselves for a cold, without taking into account the seriousness of the situation. Pay attention to signs such as muscle spasms, severe headaches and stomach discomfort, fever, vomiting, diarrhea, and rash on the palms. It is better to immediately seek help from a specialist who will prescribe appropriate tests and then treatment.

Causes

So, we have looked at the symptoms of toxic shock syndrome. Now let's discuss the causes of the disease. There are several of them.

Using tampons on a regular basis. Vaginal contraceptives. Childbirth. Disturbances in the functioning of the reproductive system. Candidiasis, bacterial vaginosis. Failure to comply with hygiene rules and improper use of Tampax. Weak immunity.

The disease develops very quickly, affecting almost all organs of the body. These include the liver, kidneys, skin and even blood vessels. The worst thing is that toxic shock syndrome can lead to death. A stable healthy immune system and good hygiene will help get rid of the infection as soon as possible.

As you can see, the reasons are visible and can be easily eliminated.

Complications of toxic shock syndrome

Like any other disease, toxic shock syndrome causes complications. Doctors include:

relapse of toxic shock syndrome;
heart, kidney and liver failure;
blood poisoning;
deterioration of vision, attention, hearing.

Treatment of an infectious disease

Treatment for toxic shock syndrome can be long and drawn out. After first aid is provided to the victim, therapy of the highest intensity is prescribed.

Includes observation, restoration of vascular function, maintaining blood pressure in a normal state, the use of glucocorticoids, antibiotics, and the use of antistaphylococcal immunoglobulin. With timely treatment, you can get rid of the manifestations of the disease within 2-3 days.

The dangers of using tampons

So, one of the reasons for the development of the disease is the uncontrolled use of tampons. Let's look at their composition. Innovative models have components that, if used frequently, negatively affect a woman’s body.

Dioxin. The substance is used as a bleach. This component can cause cancer, disrupts the functioning of the immune and reproductive systems, causing endometriosis.

Viscose. It absorbs blood in the best way, but when the tampon is removed, the fibers of the component may remain on the mucous membrane.

Cotton. The fibers that remain on the vaginal walls when the tampon is pulled out are associated with the appearance of ulcers and minor injuries.

But these are not all the negative aspects of using tampons. Their negative impact lies in the incorrect outflow of blood, which sometimes ensures the return of fluid.

Deformation of the inner part of the vagina (in an aerobic environment, staphylococcal syndrome rapidly develops and bacteria multiply; toxins of Staphylococcus aureus appear). A decrease in the number of lactic acid bacteria leads to activation of the pathogenic flora of the vagina.

Experts advise changing the tampon every 3-4 hours, otherwise bacteria formed in the blood will immediately spread to the genitals.

Failure to promptly replace a tampon can lead to toxic shock syndrome.

Feminine pads

On menstruation days, more than ever, you want more cleanliness, comfort and coziness. It is believed that sanitary pads are one of the effective ways to protect yourself during the menstrual cycle.

But these protective measures are dangerous to health. 63% of diseases in women develop due to their improper use.

Types of gaskets

Today on the hygiene products market you can find a fairly wide selection of pads. They are disposable and reusable. Among them, there are pads for regular use (they absorb blood of medium intensity).

For daily use (they will become indispensable for small and weak mucous secretions, and also eliminate unpleasant odors).

They are ultra-thin (the structure of the models is quite thin, but they absorb very small amounts of moisture).

M axi (they have a fairly decent size and absorb a large amount of secretions; such models are used for long trips or during night sleep).

With special sleeping pads (ensure a restful night's rest, complete protection from unexpected stains).

How to choose gaskets

Despite the wide range of products on the consumer market, all products have the same structure.

The topmost layer of the gasket consists of an artificial or cotton mesh (it has a big advantage because it is always dry and does not subject the product to deformation). The inner layer consists of a special filler (it thoroughly absorbs moisture and quite often causes skin irritation). The bottom layer is made of polyethylene or a breathable material that does not allow liquid to pass through.

Each package with pads has a designation in the form of droplets, which indicates the absorption coefficient of the product (the more of them, the higher the level of absorption; “wings” perfectly protect underwear from stains and unpleasant contamination).

Most manufacturers produce scented hygiene products to eliminate unpleasant odors, but they can cause allergies (when purchasing, do not forget about this danger).

Situations of thrush appearing after the use of scented pads are known.

I advise you to buy hygienic protective products that are odorless and colorless - think about your safety.

Negative effects of gaskets

It may seem that the pads are harmless. But this is a mistaken opinion. What disadvantages do they have?

During active walking, the pads become wrinkled or move to the side. You feel discomfort while using this hygiene product. Allergic reactions appear, unpleasant itching and irritation are felt. Cystitis or thrush occurs, and an unpleasant odor occurs.

Pads prevent you from leading an active lifestyle. A greenhouse effect is created, allowing infections to penetrate deep into the cervix or remain on the mucous membrane. Otherwise, the effect of using pads is quite acceptable during menstrual periods.

Preventing toxic shock syndrome from tampons

So, tampon toxic shock syndrome is a disease caused by a bacterial infection. It is necessary to use preventive measures, and the disease will certainly bypass. During your period, alternate the use of tampons with pads and take breaks.

Buy products with absorbent capacity that will accommodate the amount of blood discharge. Change the product every 3-4 hours.

If you don’t know how to replace pads and tampons, read about menstrual guards.

So, today you learned about a disease called toxic shock syndrome from tampons. Surely, you should have been surprised by the dangerous components that make up seemingly absolutely harmless tampons.

I think that a menstrual cup is a good alternative to the hygiene products described above. What do you think? Share your opinion in the comments.

Best regards, Tina Tomchuk

Tampons appeared in the distant 30s. Since that time, they have become a real lifesaver for girls. Thanks to these hygiene products, during your period you can wear tight clothes, play sports, dance, go to the pool and not feel any discomfort.

But many gynecologists are against tampons. Some health problems are associated with their use: thrush, inflammatory processes, dysbacteriosis. Tampon shock is the most dangerous disease. How to avoid unpleasant consequences from using these hygiene products, we will consider in the article.

Toxic shock syndrome

Toxic shock syndrome (TSS) is a manifestation of severe intoxication (poisoning) of the body with bacteria. The disease develops at lightning speed and always occurs in an acute form.

It is important! You will not be able to cope with toxic shock syndrome on your own. At the first symptoms of the disease, a woman must seek medical help. Otherwise, complications can spread to the kidneys and liver, up to complete failure of these organs.

Toxic shock syndrome is caused by a number of bacteria and microorganisms:

streptococci;
staphylococci;
malarial plasmodium.

Bacteria “throw out” toxins into the blood, thereby poisoning the woman’s body. Through the plasma they reach the main vital organs (liver, kidneys, brain), and the patient experiences an acute pathological condition.

Why don't all women who use tampons during their periods suffer from TSS? The thing is that most adults have already encountered similar bacteria or microorganisms at least once in their lives and have developed antibodies to toxins.

That is why toxic shock syndrome in most cases is observed in adolescents and girls under 30 years of age.

The first signs of TSS resemble the common flu:

increased body temperature (above 39 degrees);
blood pressure surges;
convulsions;
dizziness and loss of consciousness;
body aches.

Many patients think that they have caught a regular flu virus and begin active treatment for a cold, not realizing the seriousness of the situation. The insidiousness of toxic shock syndrome is that the disease develops rapidly. If you do not remove the tampon in time and do not seek medical help, you can experience complications, including death.

First symptoms

TSS occurs very quickly during menstruation and is always acute. Without proper treatment, death can occur within 3–4 days.

That is why every girl who uses tampons should know the symptoms of toxic shock syndrome:

Low blood pressure. There is perspiration and pale skin on the patient's face. It gets to the point where the woman cannot remain in an upright position and loses consciousness.
Increased body temperature (39-40 degrees).
Nausea, vomiting, loose, foamy stools.
Muscle pain, cramps.
Redness of the throat mucosa.
The occurrence of conjunctivitis, souring of the eyes.
Small amount of urine.
Swelling of the genital organs.
Sharp pain in the lower abdomen and lumbar region.
Labored breathing.
On days 4-5, red spots may appear on the skin, which look more like burns.
On days 7-14, the skin on the palms and soles begins to peel and peel off.
Development of sepsis.
Damage to the liver, kidneys, central nervous system.

It is important! If, while using tampons, your stomach hurts severely, your temperature rises, or your blood pressure drops, seek medical help immediately. In 80% of cases, the doctor will diagnose TSS. You should not wait for accompanying symptoms and worsening of the condition. At the initial stage, toxic shock syndrome responds well to treatment, complications are extremely rare.

Specific treatment for toxic shock syndrome

It is worth remembering that TSS is an insidious disease that progresses very quickly. Therefore, his treatment will be long and painful.

First aid for a woman who detects symptoms of TSS should be as follows:

Removing the tampon.
Ventilate the room so that there is access to oxygen.
Relief from constricting, closed clothing.
Bed rest.
Warm heating pad for your feet.
Call an ambulance.

Prevention of the syndrome

Is it really impossible to avoid TSS when using tampons? To prevent this disease, doctors advise adhering to the following rules:

The time of using tampons should not exceed 4 hours. In this case, the risks of developing pathogenic bacteria are minimized. In isolated cases, the time can be increased to 8 hours. After this, be sure to wash yourself with intimate hygiene gel to restore the vaginal microflora, and put on a pad.
Do not use tampons at night.
Choose the right size of hygiene product and its absorbency.
Alternate wearing tampons with pads.
Choose hygiene products of appropriate, proven quality. Make sure that the tampon does not contain genetically modified cotton, which is often used by manufacturers to reduce the cost of the product. If this component is present, the risk of developing staphylococcal toxins increases dramatically.
If after using a tampon there is itching, burning or redness in the vagina, it is better to avoid these hygiene products.

The life of a modern girl is designed in such a way that she always needs to be in shape, even during her period. Undoubtedly, tampons are simple and convenient to use, they are invisible under clothing and do not hinder movement. But, nevertheless, every girl, using these hygiene products, should know and use the rules that were described above. In this case, the risks of developing TSS are minimal.

Update: October 2018

In recent years, sanitary tampons have become widespread among women. This fact is not surprising, because tampons allow you to go to the pool and the beach, wear tight-fitting and light-colored clothes during menstruation, dance and generally lead a normal lifestyle. However, many manufacturers of this hygiene product are silent about such a serious fact as the development of toxic shock syndrome from tampons. This pathology, although rare, progresses very quickly, is difficult to treat, and in 5% (according to some data in 8–16%) ends in death.

Historical reference

The history of the existence of hygienic tampons goes back several thousand years. The first hygiene products, only vaguely reminiscent of tampons, appeared in Ancient Egypt, which Egyptian women made from flax fibers. In ancient Rome, women rolled soft wool into rolls and greased them for easy insertion and removal. Representatives of the fairer sex of Syria and Babylon rolled papyrus (for rich ladies) or reeds (for poor women). In Japan, to make life easier on critical days, rice paper was used, rolled into balls the size of a walnut. Eskimos used moss or very thin alder wood shavings to produce so-called tampons, and some used fur as the basis for tampons.

The second birth of hygienic tampons is considered to be the thirties of the last century. This hygiene product was invented and patented by US doctor Earl Haas. The tampons created by Haas were made from compressed cotton wool, which was wrapped in gauze. A US citizen, German Gertrude Tenderich, turned out to be more enterprising, who bought the patent from the founder of tampons and opened the Tampax company. Those first tampons did not shine with special convenience and comfort.

But these hygiene products were constantly being improved. Later, tampons had a thread, pulling on which made the process of removing it easier. Later they were joined by applicators, with the help of which the insertion of tampons became more convenient. But one mistake by tampon manufacturers almost brought down the entire hygiene campaign to improve life during menstruation.

In an effort to maximize the absorption (absorbing) properties of tampons, Procter & Gamble decided to replace the cotton and viscose that make up tampons with a synthetic material that absorbs liquid well and is impregnated with a hyperabsorbent. This hyperabsorbent was a food thickener and was called cellulose gum.

It was this component of hygiene products that laid the foundation for toxic shock syndrome from tampons. The absorbent caused vaginal dryness, as a result of which its mucous membrane was easily injured when removing the tampon, allowing bacteria access to the blood vessels. In addition, cellulose gum disrupted the normal vaginal microflora, thereby allowing pathogenic bacteria to multiply.

In the 80th year of the 20th century, doctors noted a strange trend - the incidence of this syndrome has increased greatly among women, although the pathology is usually observed in burn patients. 800 women were affected, and 38 of them died. After analyzing the incidence, it became clear that the trigger point for the emergence of toxic shock syndrome was the use of hygienic tampons. All products were withdrawn from sale and the percentage of cases fell sharply.

Between 1976 and 1996, 5,296 women were diagnosed with TSS. Today, TSS affects one in 100 thousand people. However, it does not follow from the above that TSS affects only women of reproductive age who use sanitary tampons. The percentage of TSS cases in men is 15 of the total number of reported cases. In addition, even refusing to use these hygiene products will not prevent the development of TSS if the immune system is weakened.

What are the dangers of modern tampons?

Modern hygienic tampons are not only convenient and comfortable to use and make life easier during menstruation. The components from which tampons are made can have a negative impact on women's health if used continuously:

Dioxin

Dioxin is used as a bleach to make the tampon white. It is considered a potential carcinogen, meaning it can cause cancer. Due to the toxic reactions that this component causes, significant disturbances occur in the reproductive and immune systems. Dioxin reduces the number of sperm in the ejaculate and provokes the occurrence of endometriosis in the body of women. This chemical component decomposes extremely slowly, which leads to its accumulation in the body. Therefore, the risk of the negative effects of dioxin increases significantly with regular use of tampons, although manufacturers believe that the content of this component in tampons is very low and does not affect health.

Viscose

Excellent absorbent - absorbs blood well. Viscose is made from wood and treated with dioxin. When the tampon is removed, viscose fibers remain on the vaginal mucosa. Thus, a tiny dose of dioxin continues to affect the body.

Cotton

Experts say that genetically modified cotton is used to produce tampons, which increases the resistance (resistance) of bacteria to antibiotics. Women who use tampons cannot recover from inflammatory processes in the genital organs longer. Also, after removing the tampon from the vagina, cotton fibers remain on its mucosa, which are only partially removed with vaginal discharge. The remaining fibers provoke the appearance of microtraumas and ulcers, which facilitates infection by pathogenic bacteria, in particular, latent sexually transmitted infections.

In addition, the negative impact of hygienic tampons is:

obstruction of the outflow of menstrual blood containing staphylococcal endotoxins, which can result in backflow of blood into the uterine cavity, from there into the tubes, and then into the abdominal cavity;
changing the internal environment of the vagina (anaerobic becomes aerobic, in which Staphylococcus aureus feels great and begins to actively multiply);
absorption of magnesium ions, which suppress the production of toxins by Staphylococcus aureus;
absorption of the nutrient substrate of lactic acid bacteria, which reduces their number and leads to the activation of opportunistic vaginal microflora.

Definition of toxic shock syndrome

Tampon toxic shock syndrome, or TSS (also known as menstrual toxic shock syndrome), is a rare and serious condition that is caused by a bacterial infection. This pathology develops acutely and affects almost all organs and systems of the body (lungs, liver and kidneys, blood vessels and skin. Exposure to toxins produced by Staphylococcus aureus leads to the occurrence of TSS. Despite the similarity of the symptoms of this pathology with those of the flu, TSS is characterized by a sudden and a rapid onset (a sharp deterioration in the condition occurs within several hours) and a high probability of death.

Researchers at the National Institutes of Health believe that using sanitary tampons increases the chances of developing the disease by up to 50%.

Epidemiology

TSS is characterized by:

occurrence in women of a certain age group (from 17 to 30 years), which is due to insufficiently developed immunity;
development in 55% during menstrual flow;
using tampons during menstruation in 99% of TSS cases;
TSS, which is not associated with vaginal infection, is diagnosed equally often in both men and women, and can occur in both newborns and the elderly;
TSS can occur in any situation when the immune system is weakened, which contributes to the proliferation of Staphylococcus aureus and its production of toxin (influenza, ARVI, wound infection);
recurrence of toxic shock syndrome occurs in 30 - 60% of cases, especially if antistaphylococcal therapy was not carried out.

Causes and mechanism of development

TSS from tampons is caused by opportunistic bacteria - Staphylococcus aureus (Staphylococcus aureus), which is part of the normal vaginal microflora in every fifth to tenth woman. For the time being, Staphylococcus aureus behaves quite peacefully. But as soon as the immune system weakens and microcracks appear on the vaginal mucosa, the bacterium becomes pathogenic, and very aggressive. It is not so much the bacteria themselves that play a role in the development of TSS, but the endotoxins they produce. Massive production of toxins disrupts the functioning of almost all organs and systems, which leads to the development of TSS.

Pathogenesis of TSS

A huge amount of toxins penetrates into the circulatory system through small vessels. The influx of toxins provokes a sharp release of adrenaline and other biologically active substances into the bloodstream. Due to the action of adrenaline, post-capillary venules and arterioles spasm, and additional arteriovenous shunts open. But blood entering the shunts is not able to fully supply the internal organs with oxygen, which leads to the development of ischemia in them and metabolic acidosis (decreased blood pH). As a result, blood circulation is impaired and hypoxia occurs in the tissues.

Damage to body systems is caused by the deposition of blood in capillaries, and its liquid part enters the intercellular space. Accordingly, hypovolemia develops (a sharply reduced volume of circulating blood, which causes a drop in blood pressure). Kidney perfusion (blood supply) also decreases, which inhibits glomerular filtration (formation of primary urine). Kidney swelling occurs, and then acute renal failure. Similar processes are observed in the lungs with the development of respiratory failure and pulmonary edema.

Features of Staphylococcus aureus

This type of microorganisms is characterized by:

high pathogenicity;
resistance to adverse environmental conditions;
the ability to penetrate any organs;
presence (in small quantities) on the skin and mucous membranes.

However, not all women develop TSS, even with regular use of tampons, why? The fact is that many adults (about 80%) are immune to Staphylococcus aureus toxin. Antibodies to endotoxins are developed throughout life (skin infections, surgical interventions, etc.). The stronger the immune system, the less chance Staphylococcus aureus has of making a hole in it. Therefore, this pathology is common among young women (under 30 years of age) who have not yet developed a sufficient amount of antibodies to the toxins of Staphylococcus aureus.

Risk factors

Menstrual toxic shock syndrome can be triggered by:

constant use of sanitary tampons;
use of vaginal contraceptives (spermicidal sponges, caps or diaphragms);
recent birth;
the presence of chronic inflammatory diseases of the reproductive system;
bacterial vaginosis, urogenital candidiasis, hidden sexually transmitted infections;
weakened immune system;
neglect of the rules of hygiene and insertion/removal of tampons;
intracavitary operations.

Clinical picture

Menstrual TSS develops suddenly, in the setting of complete health, and progresses very quickly. If left untreated, death can occur within two days. Symptoms of toxic shock syndrome include:

a significant increase in temperature (up to 39 degrees or above);
low blood pressure (the main symptom of all types of shock), inability to remain in an upright position - orthostatic syncope (fainting);
nausea and vomiting, clouding of consciousness, increased heart rate and dizziness are a consequence of low blood pressure (systolic less than 90 mm Hg);
muscle pain and spasms, convulsions (tissue hypoxia);
gastrointestinal disorder (vomiting, profuse diarrhea - watery stools) - the effect of endotoxins;
the appearance of a rash - multiple hyperemic spots up to 1 cm in diameter on the skin, reminiscent of a sunburn;
desquamation (flaking) of the skin occurs 7–14 days after the onset of TSS;
damage to the mucous membranes (redness of the vagina and oropharynx, the occurrence of non-purulent conjunctivitis, “crimson tongue”);
an increase in leukocytes in the urine in the absence of infection;
liver damage (increased bilirubin, AST and ALT);
impaired hematopoiesis (sharp decrease in platelets);
damage to the central nervous system (impaired consciousness - stupor, stupor, disorientation, hallucinations even against the background of normal temperature and pressure);
damage to the cardiopulmonary system (pulmonary edema, respiratory distress syndrome, heart block);
development of sepsis;
sowing Staphylococcus aureus from the cerebrospinal fluid and from the pharyngeal mucosa.

Diagnostics

The presence of TSS can be suspected by the characteristic clinical signs and appearance of the patient (sluggish, lethargic, with severe pallor and cyanosis). If the patient has an unexplained fever, multiple lesions of the body systems against the background of skin flushing and rash, and associated with menstruation, the doctor must first exclude/confirm TSS.

Clinical tests:

General (detailed) blood test

Determination of erythrocytes and hemoglobin (reduced), leukocytes (increased, shift of the formula to the left, possible lymphocytopenia), platelets (reduced), clotting time and bleeding time 9 coagulopathy).

Blood chemistry

Decreased total protein and albumin, electrolyte imbalance, decreased calcium, phosphorus and magnesium, increased nitrogen and creatinine, AST and ALT, increased bilirubin and calcitonin.

General urine analysis

Azotemia, significant leukocyturia (sterile pyuria), detection of leached red blood cells.

Tank. biological fluid cultures

For cultures, smears are taken from the vagina and rectum, from the cervix, conjunctiva, oropharynx and nose. They also “sow” blood, urine and cerebrospinal fluid.

Tests for other, similar infections

Tick-borne rickettsiosis and leptospirosis, sepsis and typhoid fever, streptococcal infection (scarlet fever) and meningococcal infection.

Determination of antibodies to Staphylococcus aureus

There are no antibodies.

In addition, fluorography is mandatory (determining the degree of lung damage and respiratory failure.

Treatment

Treatment for toxic shock syndrome is long and complex. All patients are necessarily hospitalized, and in the intensive care unit, where intensive therapy is carried out, aimed at restoring the functioning of damaged organs and systems.

First aid

If a woman is suspected of having TSS, loved ones should immediately call an ambulance and take a number of measures:

remove the sanitary tampon or local contraceptives (caps, diaphragms) if possible;
unbutton clothes to make breathing easier;
put the patient to bed, apply a heating pad to her feet;
open the window for fresh air.

Intensive therapy

Bed rest, dynamic monitoring of the patient

Measuring blood pressure and temperature, counting pulse and respiration rate.

Restoring intravascular volume

To eliminate hypovolemia, intravenous infusions of saline solutions (physiological, Ringer's solution and glucose) and fresh frozen plasma are prescribed in a volume of 4 - 5 liters per day (in some cases, the amount of injected fluid is increased to 8 - 12 liters).

Raising and maintaining blood pressure

Dopamine is injected intravenously (continuously) starting at a dosage of 2–5 mcg/kg per minute, then the dose is gradually increased until normal numbers are reached. Dopamine increases myocardial contraction and heart rate, dilates renal, mesenteric (intestinal) and cerebral vessels, and constricts skeletal muscle vessels, which leads to normalization of blood circulation in vital organs.

Administration of glucocorticoids

Glucocorticoids have antishock (blood pressure support), anti-inflammatory, antiallergic, antitoxic and immunosuppressive effects. As a rule, dexamethasone or prednisolone is prescribed (orally, intramuscularly or intravenously, depending on the patient's condition).

Administration of antibiotics

The selection of antibiotics is carried out taking into account their resistance to beta-lactamase and activity against staphylococci. Prescribing antibiotics does not reduce the duration of the acute phase of toxic shock and does not relieve clinical signs, but significantly reduces the frequency of relapses of TSS. Preference is given to penicillins (amoxiclav, oxacillin, methicillin, nafcillin) and cephalosporins. In case of allergy to penicillins, vancomycin, clindamycin, dapotmycin or linezolin are prescribed. Antibiotics are administered intravenously, then intramuscularly.

Prevention of respiratory disorders

This is carried out using oxygen, which is supplied through a mask or nasal cannula. At the same time, arterial blood gases are monitored. In cases of respiratory failure, the patient is transferred to artificial ventilation.

Normalization of hemocoagulation

If the coagulogram deviates from normal values or there are signs of bleeding, colloidal solutions (infucol, reopolyglucin), fresh frozen plasma, cryoprecipitate are administered intravenously, or donor blood is transfused. If there is a sharp decrease in platelets, platelet mass is administered.

Antistaphylococcal immunoglobulin

The drug is administered intravenously when the patient is in serious condition. Immunoglobulin contains antibodies that neutralize Staphylococcus aureus toxins.

With timely and adequate treatment, normalization of body temperature and blood pressure occurs within two days after the start of treatment. Laboratory parameters return to normal by the end of the 1st - 2nd week, and the restoration of hemoglobin and red blood cells after 4 - 6 weeks.

Complications of TSS

Possible complications of the disease:

relapse of TSS usually occurs within the second month after treatment in patients who were not prescribed beta-lactamase-resistant antibiotics (60%)
renal and liver failure;
death (in 5%);
heart failure;
decreased mental abilities (concentration, intelligence, memory impairment);
sepsis.

Question answer

Question:
I had TSS from tampons about two months ago. She was discharged from the hospital with recovery. But now I noticed that my hair began to fall out a lot and my nails were peeling. What to do?

Splitting of nails and hair loss are consequences of the disease. Do not panic, these phenomena are reversible. Take multivitamins, stimulate nonspecific immunity, perform cosmetic procedures for hair and nail care (nail baths, rinsing hair with decoctions of medicinal herbs, medicinal masks).

Question:
I prefer to use sanitary tampons, but I learned about a possible complication when using them - TSS. What should I do to prevent this disease from occurring?

First, you must wash your hands thoroughly when inserting and removing a tampon. Secondly, do not allow the tampon to remain in the vagina for a long time (more than 4 hours) and remove it, even if it is not yet completely saturated. Thirdly, use tampons with a low degree of absorption (requires frequent replacement and is less damaging to the vaginal mucosa). Also, at night and on days of minor bleeding, replace tampons with pads. It is not recommended to use tampons with aromatic additives, especially for women prone to allergies. It is prohibited to insert tampons against the background of acute or exacerbation of the inflammatory process in the female genital organs and after suffering from TSS.

Question:
Why can't you get TSS from using pads? What is the difference between pads and tampons for TSS?

Because the tampon is located inside the body, where it accumulates blood - the optimal nutrient medium for Staphylococcus aureus. Toxins released by bacteria immediately penetrate into the bloodstream through microcracks that appear during the insertion and removal of tampons. In addition, “old” blood along with pathogenic microbes from the tampon can enter the uterus, from there into the abdominal cavity (for example, I forgot about the tampon at the end of menstruation, when I inserted it to absorb residual minor secretions, and forgot to remove it). Pads do not cause microtrauma to the external genitalia, do not cause blood stagnation in the vagina and are changed in a timely manner (the woman sees that the pad is no longer suitable for use).

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!