TSS: symptoms and progression of toxic shock syndrome

Toxic shock syndrome (TSS) is a serious illness. It is rare, occurring as a complication after a bacterial infection. Toxic shock can occur in anyone of any age group or gender. However, 95% of all cases of toxic shock syndrome involve women aged 15 to 20. Younger people in particular are at higher risk because their immune system has not yet produced sufficient antibodies.

The toxins of certain bacteria are the triggers of TSS. The syndrome occurs either during or independently of menstruation. Menstrual TSS is usually caused by the bacterium Staphylococcus aureus. Non-menstrual TSS is occasionally triggered by Streptococcus pyogenes. However, streptococcal toxic shock syndrome is less common.

The two types of bacteria occur naturally in small quantities on many people’s skin and mucous membranes. They do not cause any issues there, as they are blocked from entering the body by the natural barrier formed by the skin and mucous membrane. In addition, the immune system produces antibodies against the toxins.

However, toxic shock syndrome occurs when the immune system is exposed to large amounts of staphylococcal or streptococcal bacteria against which it has not yet produced antibodies. This leaves it unable to fight the pathogens effectively.

You can recognise toxic shock syndrome by various symptoms. Typical signs include:

• Flu-like complaints such as nausea and vomiting, headaches, chills and high fever
• Low blood pressure
• Weakness
• Disorientation and dizziness
• Reddened mucous membranes
• Rash on soles of feet and palms of hands, which scales after a while

In toxic shock syndrome caused by tampon use, the symptoms do not differ from non-menstrual TSS. Both variants of TSS always cause fever and progress quickly.

Important: consult a doctor immediately as soon as the first symptoms of TSS appear.

Toxic shock syndrome: when do symptoms occur?

Toxic shock syndrome develops rapidly and requires immediate attention when the first symptoms of TSS appear. How quickly they appear depends on the type of infection. With non-menstrual TSS, those affected usually display their first symptoms around 48 hours after infection. In the case of menstrual toxic shock, the symptoms usually occur during menstruation. In the first 1 to 3 days, sufferers usually experience fever, low blood pressure, vomiting, diarrhoea and headaches. The typical rash also occurs during this time. After about 2 to 10 days, mucosal redness develops and sufferers feel weakened. After about 1 to 2 months, they lose their hair and nails due to TSS.

Toxic shock syndrome: possible consequences

A serious consequence of TSS is organ failure. Toxic shock syndrome causes a sharp drop in blood pressure. As a result, the heart no longer supplies enough blood to the other organs, causing them to stop functioning. The mortality rate for streptococcal TSS is around 60%. With menstrual staphylococcal TSS, on the other hand, about 95% of women recover. Around 80% of patients with non-menstrual staphylococcal TSS survive.

If you have severe symptoms, you should go to hospital immediately. If more than one characteristic symptom is present, further examinations are carried out.

Doctors treat toxic shock syndrome in hospital on an inpatient basis. They take various measures:

• If you develop TSS during your menstruation, your doctor will check whether a tampon or a menstrual cup is the trigger. They will remove this sanitary product immediately. If the source of the bacteria is in a wound or inside the body, the doctor will disinfect the affected area or perform an operation.
• Patients are given antibiotics that kill and block the bacteria. Doctors also use antibody preparations to render the toxins harmless. The doctor stabilises your blood circulation with an infusion. They also use additional medication (corticosteroids) to inhibit the response of your immune system.
• In some cases, the functioning of the internal organs is already affected by the bacterial toxins. If so, the doctor will try to maintain organ functions. This is done in intensive care.

Do you want to prevent toxic shock syndrome? Then take the following hygiene measures:

• Always wash your hands before inserting or removing a tampon or menstrual cup.
• Use the correct tampon size to prevent TSS. This depends on the level of your period flow. If it is light, use small tampons with low absorption.
• Make sure you change your tampon or menstrual cup every 3 to 6 hours. Never wear either product for more than 8 hours. If you insert the tampon or menstrual cup before going to bed, change it as soon as you get up.
• Never leave a tampon out of its packaging and ensure you insert it straight away.
• Always clean your menstrual cup with hot water and a mild gel detergent before inserting it. You should also boil the cup and its container regularly – after your period, at the latest.

You can protect yourself against non-menstrual TSS by treating wounds and infections hygienically and correctly. The best thing to do is to contact your doctor. The same applies if you notice the initial symptoms of toxic shock. Toxic shock syndrome is a rare but serious illness. But with the right measures, you can effectively help prevent it.