Toxic Shock Syndrome (TSS)
Toxic Shock Syndrome (TSS) is a rare but serious disease associated with tampon use. TSS occurs in men, children, and non-menstruating women as well. All tampons on the U.S. market today are associated with an equally low risk of TSS. Today, the annual incidence rate of TSS in women of menstrual age in the United States is about one case per 100,000 women.
Every woman who purchases a carton of tampons in the United States and Canada today receives important safety information about TSS, ways to minimize her risk of TSS and advice on what to do if she experiences the signs and symptoms of TSS.
Identification of TSS
TSS was first described in 1978 by Dr. James Todd based on cases in seven children, three of whom were boys. The illness is caused by toxins produced by specific strains of Staphylococcus aureus. Most people have the antibodies in their bloodstream to protect them from the toxin, if it is produced. TSS is characterized by fever, hypotension, rash and multi-organ dysfunction. In the vast majority of cases, women who contract TSS recover after treatment, but it is vital that women recognize the signs and get immediate treatment if they are menstruating and using a tampon.
TSS is a rare illness. The U.S. Centers for Disease Control and Prevention (CDC) reports, for the United States, a menstrual TSS case incidence rate of 1/100,000 in women of menstruating age per year and an overall TSS case incidence rate of 0.53/100,000 people per year. Epidemiological evidence shows that the incidence has remained essentially unchanged since the 1980s.
TSS studies show several possible risk factors for menstrual TSS, including:
- tampon usage
- young user age
- continuous use of tampons
- absorbency of tampons
This is why it is important for women to interrupt their tampon usage with pads from time to time during their period, and to use the lowest absorbency tampon for their flow.
Night time use and tampon wear time were show to NOT be risk factors for TSS in these important studies.
Despite tampon use as a risk factor, tampons are neither a source of S. aureus (the bacteria that causes TSS), nor do they increase the likelihood of the organism being present in a woman’s vagina, nor do they increase the numbers of organism present in the vagina.
Be aware of the signs and symptoms of TSS. If you start to feel sick, remove your tampon, see a doctor immediately and tell her you think you might have TSS. Symptoms include:
- onset of flu-like symptoms such as fever (102°F)
- vomiting, diarrhea
- sunburn-like rash
- dizziness, muscle aches
- fainting/near fainting when standing up
For more information, look at the product insert found in all boxes of tampons, or read more here.
Research Relating to Cotton and Rayon Fibers
Numerous studies have demonstrated the safety of tampons made with cotton and/or rayon fibers. Extensive research has repeatedly disproven the mistaken belief that TSS risk increases because of the presence of rayon fiber in tampons :
- Four separate, independent studies failed to reproduce an earlier report asserting that rayon was associated with a higher risk of TSS.
- Epidemiological studies conducted in the 1980s confirmed that tampons made with cotton and/or rayon fibers had the lowest relative risk of TSS vs. tampons made with other compositions.
- Microbiological and laboratory studies confirmed that cotton and rayon fibers did not differ in their propensity to increase risk of TSS.
- FDA guidance states that “Tampons made with rayon do not appear to have a higher risk of TSS than cotton tampons of similar absorbency.”