Chapter 4 – The Vagina and Vulva

Toxic shock syndrome

Toxic shock syndrome (TSS) is a very rare but potentially serious illness that can affect both males and females. It is caused by bacteria that are normally commensals on the skin such as Staphylococcus aureus and Streptococcus pyogenes although in more than 30 per cent of cases no bacterial pathogen is isolated.(19)

TSS can occur after surgery and in childbirth, although in women most cases of TSS are diagnosed during menstruation in association with the use of tampons. Menstrual cups and use of the contraceptive diaphragm during menstruation have also been implicated. It is postulated that the blood on the tampon provides a culture medium for bacterial overgrowth and the exotoxin produced is absorbed into the blood stream.

Cases of TSS are extremely rare with today’s tampons, however hygienic handling and frequent change of tampons every 4 to 8 hours is advised.(20) In cases reported in men there have been concurrent staphylococcal skin infections.

Symptoms of TSS include:

sudden onset of high fever vomiting diarrhoea sunburn like skin rash joint and muscle pain headaches confusion hypotension peeling of palms and soles of feet 2-3 weeks after skin rash appears

When TSS is suspected with tampon use the tampon should be removed immediately and the person referred for emergency care. Bacterial cultures should ... Buy now

Practical advice on tampon use:

Buy now