Some Truths Behind Toxic Shock Syndrome

A couple of weeks ago, I began telling my female friends that I was considering writing a story about Toxic Shock Syndrome (or TSS). TSS is a fast moving bacterial-caused illness that can systematically shut down organs (kidneys and liver included) if not immediately treated. The syndrome is widely known among women as a morbid outcome of tampon mis-use. Leave your tampon in for more than eight hours and you are severely at risk, we are told.

My friends, who had long ago been familiarized with the facts and mythology behind TSS, each had the same response: “I don’t think it exists.” One friend informed me that she had recently lost complete track of her tampon use to no consequence, realizing three days into her period that one was wedged into the depths of her vagina. “Someone had just told me about when they forgot to take out a tampon once,” she said in a chipper voice, “and I was sitting there like, oh my god, I have a tampon in!”

None of my friends had had a TSS encounter of any type. Some of them had even fully forgotten about it. Having never have met a victim myself, I too considered the syndrome a sort of feminine urban myth. My friend’s disappearing tampon anecdote seemed to confirm its non-existence.

I began my research. Approximately 4 in 100,000 tampon users get TSS. Blanket symptoms include rapidly progressing fever and falling blood pressure, skin blanching, vomiting and diarrhea. As I read and wrote, I felt like an uninspired kid in Catholic school studying bible passages for a catechism exam. It was informative for a purpose, but no mind-blowing.

Then I read a personal account. A woman whose daughter had died from TSS posted an entry on a fact site. Her writing was honest and informative. Something about this woman masking the pain of losing a daughter with a desire to help others evade the same fate zapped me from my state of indifference. I was again the wide-eyed fourteen year old checking my watch every thirty minutes to see if six to eight hours was up yet. I called my 24hr tampon friend back. Hey, just double checking that you‘re okay. I asked her to repeat her story. As she spoke again, I felt phantom pain crawling from my cervix to my navel, then my rib cage…

If she was someone else, she could have died.

Although 4 in 100,000 is obviously a small number, the fact that TSS was practically unheard of before 1980 is not insignificant. In 1978, the company Procter and Gamble introduced the first super absorbent Rely tampons, which could contain an entire menstrual flow without leaking or needing replacement. Carboxymethylcellulose (CMC) and polyester fibers provided the mega-absorbency. Within two years, the Center for Disease Control determined that increased Rely tampon publicity had led to increased cases of toxic shock syndrome. The fibers could not filter Staphylococcus aureus, the toxic bacteria that causes menstrual-related TSS. Rely tampons were recalled, and the number of cases reported to the CDC began to decline.

Though it did not entirely disappear, TSS went off the radar. Then, in the late ’90s, Proctor and Gamble returned to the tampon scene (the company purchased Tambrands, the tampon giant that makes Tampax) and the syndrome again received a flurry of media coverage. TSS related rumors, as well as scientific evaluations of the current safety of tampons, spread quickly. Case numbers stayed low. The early 2000s did see a slight spike (one study considered it to be a result of earlier menstruation in girls), but Rely-like scandals were no more.

Toxic Shock Syndrome is caused by toxin that comes from one of two types of bacterium: either Staphylococcus aureus (think staph infections) or Streptococcus pyogenes (think strep throat). Strep TSS has nothing to do with menstruation, and not all of staph cases are menstrual-related. Strep TSS can occur in people with infected surgical wounds or respiratory infections, or in women who recently gave birth. Some Staph TSS cases can also be caused by surgical wounds. Staph bacteria can be found on the skin and in the noses of about a third of the population. Most people have antibodies that protect them against the dangerous strands of the bacteria that cause TSS--95% of women have the antibodies by the time they are thirty. They are then immune to it. People who get it once, however, are more likely to get it again.

Here I feel that I could go into more precise details of what is happening scientifically in TSS, but I’d rather hand the microphone to the mourning mother:

“The truth is, the deadly toxins begin to multiply within 2 hours after inserting your first tampon. Regular, or Super! When you change a tampon after even just a few hours that toxin remains inside just waiting for you to put in a new tampon. It takes up right where it left off when it comes into contact with the viscose rayon [a fiber often used in today’s market] in the tampon. The longer you continue to use tampons even while changing the more concentrated the toxin becomes, Once this toxin gets into your blood stream, (it can enter with only a couple of scuffed off cells from changing a tampon) it's 10,000 times more deadly than sepsis alone.

“The reason you need to use a pad at night for at least 8 hours is, you remove that rayon filled tampon and the toxin takes that 8 hours to dissipate, (die off) then in the morning you can start the deadly process all over again. Providing your tampon isn't leaving fibers behind..…”

As I reread this woman’s account, it gives me the same feeling of uneasiness it did the first time. I use tampons. I leave them in overnight. Sometimes all day. I am very much alive and this woman’s daughter very much dead. Why her instead of me? My body contains antibodies that hers did not. It is neither of our faults, it just is.

The real truth behind TSS cannot be found in the paragraphs containing the tampon industry’s shady history or the science behind the syndrome. The real truth is that people get it and people die. Medical discoveries do not have to be earth shattering to be real.