Toxic shock syndrome can occur after any infection with Staphylococcus aureus strains that produce one of the responsible toxins. It does not spread person to person. The syndrome can occur after infected surgical wounds, infections associated with childbirth, and other types of staphylococcal infections. Using tampons increases the risk of staphylococcal toxic shock, and the higher absorbency tampons may pose a greater risk. Use of intravaginal contraceptive sponges also increases risk. Most of the menstruation-associated cases occur in women under 30, probably because younger women are less likely to have protective antibody against the toxin. Recovery from the disease does not consistently give rise to immunity. In fact, about 30% of those who recover will suffer a recurrence of the disease, although it is usually milder than the original illness. Except for the tampons responsible for the 1980s epidemic, which were removed from the market, the type of absorbent fiber is probably not an important factor in the current incidence of the disease. Since 1990, there has been a slow steady decline in the incidence oftoxic shock syndrome, now estimated to be only one to two cases per 100,000 menstruating women per year. In recent years, the prevalence of non-menstrual toxic shock has been increasing and is generally more prevalent than menstruation-related cases. Close monitoring continues, however, because of the introduction of prolonged-use tampons and those of different fiber composition.
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