TOXIC SHOCK SYNDROME

Toxic shock syndrome now appears to be a world wide phenomenon. It nearly always affects young women - almost invariably tampon users - who develop the condition during periods.

Toxic shock syndrome is a potentially fatal illness that almost exclusively affects women during the course of their periods. There is very good evidence to suggest that its occurrence is related to the use of tampons during periods, particularly the new super-absorbent sorts which are based on a rayon and cellulose compound. However this evidence is not conclusive, and it is very important to remember that millions of women use tampons.

CAUSES

The important ingredients in causing the syndrome seem to be the occurrence of a period, probably the use of a tampon and the presence of staphylococci in the vagina. Although staphylococci are not invariably found in the vagina, they are present in many more cases with the syndrome than not. It has been suggested that when the staphylococcus is present in the vagina, and a period starts, then the presence of a blood-soaked tampon will provide an excellent culture medium for the organisms to grow on. It is thought that the symptoms result from the production of a toxin (poison) by the backwards up through the vagina, uterus the peritoneal lining inside of the abdomen.

About 95 per cent of reported cases have happened in women who are having periods. The syndrome tends to occur in very young women, with the average of 23, and 30 per cent of cases happen in girls aged between 15 and 21. No particular type of tampon has been associated with the disease, although it is possible that the new super-absorbent types, which have become widely used since the 1970s, may have some part to play.

Curiously, the disease seems to be less common in women who are using the Pill. This could perhaps be explained by the fact that the amount of menstrual flow is reduced, but this can’t be the only explanation.

SYMPTOMS AND DANGERS

Toxic shock syndrome is characterized by a high fever of over 39degC (102.2degF), a low blood pressure (shock, in the emergency doctor’s language); a flattish skin rash that leads to on to the loss of skin from the hands and feet after a week or two; and often a quite marked eye infection.

Additionally, there will be involvement of at least four of the body’s main systems. Failure of the kidneys is very common, as is diarrhea. There is nearly always myalgia - aching pains in the muscles - of the sort people get with ‘flu. Headaches and disorientation occur, and there may be evidence of disturbance of the function of the liver.

Typically the illness develops suddenly on the fourth day of a menstrual period. The fever occurs first, and there may be abdominal pain. Watery diarrhea develops during the first 24 hours, but it may not be noticed and may be mistaken for the first flush of fever. Later it becomes more marked, usually affecting the fingers, and sometimes the palms and the soles.

As the disease progresses, other problems such as pain in the joints and discomfort on looking towards a light (photophobia) may occur. The kidneys often fail, and stop passing enough urine so that level of waste products in the blood starts to rise. The kidney failure is probably related to the drop in blood pressure, as the kidneys are very sensitive to any changes in the amount of blood flowing to them.

Most patients recover after 10 days, but at a rather late stage, the skin is lost from the palms and soles, and often from the face and even the tongue. The death rate from the disease is not easy to assess, but it is probably around 2 or 3 per cent.

TREATMENT AND OUTLOOK

The most important aspect of the treatment is replacing fluid intravenously in order to correct the working of the circulation. The other problems that can happen have to be faced as they occur; a patient running into breathing difficulty might have to be put on a respirator, for example. There is no evidence that the infection with staphylococci involves the blood, but it is very worth while treating the patient with antibiotics to eradicate the organisms from the vagina. Not only may this hasten recovery from the illness, but it may also prevent repeated attacks.

PREVENTION

The best way to avoid the syndrome is to change tampons regularly and frequently during a period. Although there is no direct evidence that this helps, it seems reasonable on the basis of what we know of the disease. If possible, it may be wise to try external protection in the form of sanitary pads during the later stages of the period. Although there seems little doubt that the disease is directly related to the use of tampons, few women would be prepared to forgo their use completely to avoid such an uncommon conditions.