By Arush Emmanuel Michael
Every doctor, while studying medicine, is made to study certain characteristic features of a disease and the epidemiology of the condition. As and when a patient of a specific demographic comes out with these features all fingers point to one diagnosis which is further confirmed by utilizing sophisticated investigations. When a woman presents to the emergency department of a hospital with a fever and low blood pressure, the causative factors can be anything and everything however when a sunburn-like rash and a history of use of tampons is present along with the above symptoms the condition is known as Toxic Shock Syndrome should go through every doctor's head.
Toxic Shock Syndrome is caused by the bacteria Staphylococcus aureus. So how does this weird sounding small bacteria cause such a deadly disease? Bacteria are readily present in our environment and Staphylococcus bacteria are especially known for causing various skin infections, urinary tract infections and food poisoning. Toxic shock syndrome is predominantly known as being caused by tampons used by menstruating women; however, it can also develop in men and women as a complication of surgical wound infections, osteomyelitis, abscesses and various other conditions. The bacteria situate itself in the vagina most frequently after improper and abnormal tampon use. After colonizing the vagina, the bacteria start producing the toxin responsible for toxic shock syndrome. This toxin seeps into the blood and acts as a super antigen, which in simpler terms means that it stimulates the cells in the body to release interleukins and tumor necrosis factor which elicits the deadly condition that is Toxic Shock Syndrome.
A tampon placed in the vagina during menstruation gets saturated with blood over a period of time. This tampon now soaked with blood acts as a medium for the multiplication of bacteria which produces toxins that are absorbed into the bloodstream. Super absorbent tampons tend to dry out the vagina if the flow is too light, a dry vagina tends to develop tears more easily when sliding in tampons as a result the toxins produced by staph can easily enter into the blood and manifest the disease. Clothing, deodorant, alcohol intake, cigarette smoking and sexual activity are unrelated to toxic shock syndrome.
The syndrome can develop in a multitude of ways and if you use a tampon on a regular basis you should always be looking out for the signs and symptoms of the condition. A sudden high fever that tends to spike intermittently is a classical sign when combined with low blood pressure. Dizziness, nausea, fainting, blurred vision, dehydration and lack of concentration are symptoms elicited if you have low blood pressure. The sunburn-like rash develops particularly on your palms and soles of feet a few hours after the above symptoms present. In people with darker skin, the colour of the skin might not be visible but it appears red in fair-skinned people. Eventually, the rash undergoes scaling and peeling just like sunburn.
In many cases, Toxic Shock Syndrome is an emergency condition and the patient is unable to bring themselves to a hospital. Approaching a healthcare centre near you should be your first move as soon as you observe anything similar to the above signs if you are able to do so. The doctor shall ask you or the person accompanying you to explain exactly what happened and what brought you to the hospital. The doctor shall then inspect and examine you after taking your or your companion's consent. In order to confirm the diagnosis of Toxic Shock Syndrome, certain investigations are necessary. Blood and urine samples are collected for culture or serological tests to check Staphylococcal or Streptococcal bacterial infection. A swab from the vagina, cervix or throat can also be collected for different microbiological tests to confirm the same. If the condition has progressed to affecting different organs a CT scan, lumbar puncture and chest X-ray can also be done. Depending on the healthcare centre, different modalities can be utilized to confirm the diagnosis at hand. . In case you do contract the infection, the treatment consists of antibiotics, intravenous fluids, medication for low blood pressure and any other treatment methods necessary to fight the infection depending on the extent of infection.
So should you stop using tampons fearing toxic shock syndrome? The answer is no, proper usage of tampons will prevent the development of toxic shock syndrome. Certain things need to be kept in mind to ensure the proper utilization of tampons. Tampons are supposed to be changed every four to six hours and more often if needed according to the menstrual flow. An alternation between sanitary pads and tampons is another method that can be utilized. Super absorbent tampons should not be used if the menstrual flow is reduced as it increases the chances of micro-tears in the vaginal wall lining. You should never insert tampons without washing your hands or if you have sharp long nails as it can cause abrasions in the vagina.
References:
https://www.healthline.com/health/toxic-shock-syndrome#TOC_TITLE_HDR_1
https://www.webmd.com/women/guide/understanding-toxic-shock-syndrome-basics
https://www.medicalnewstoday.com/articles/tss-rash#other-rash-causes