Prevention and Treatment

Compared to 1980, when more than 1,100 cases were reported, only 100 to 200 cases have been reported each year since 1994. The improved figures result largely from better understanding of how to use vaginal tampons, and withdrawing from use certain highly absorbent types that promoted development of the disease. The incidence of toxic shock syndrome associated with the use of menstrual tampons can be minimized in these ways:

■ Hands should be washed thoroughly before and after inserting a tampon.

■ Use tampons with the lowest absorbency that is practical. Since 1990 the law requires that absorbency be stated on the package, ranging from less than 6 to 15 ml.

■ Tampons probably should be changed about every 6 hours and a pad instead of a tampon used while sleeping. Tampons for overnight use introduced in the last few years, however, appear so far to be safe.

■ Trauma to the vagina should be avoided when inserting tampons.

■ Tampon users should know and understand the symptoms of toxic shock syndrome, and remove any tampon immediately if they occur.

■ Tampons should not be used by persons who have had toxic shock syndrome previously.

Staphylococcal toxic shock syndrome can be effectively treated with an antistaphylococcal medication, intravenous fluid, and other measures to prevent shock and kidney damage. Most people recover fully in 2 to 3 weeks. The mortality rate is approximately 3%.

Table 25.5 describes the main features of toxic shock syndrome.

Table 25.5 Staphylococcal Toxic Shock Syndrome

Symptoms

Fever, vomiting, diarrhea, muscle aches, low blood pressure, and a rash that peels

Incubation period

3 to 7 days

Causative agent

Staphylococcus aureus, certain toxin-producing strains

Pathogenesis

Toxin (TSST-1 and others) produced by certain strains of S. aureus; toxins are superantigens, causing cytokine release and drop in blood pressure

Epidemiology

Associated with certain high-absorbency tampons, leaving tampons in place for long periods of time, and abrasion of the vagina from tampon use. Also as a result of infection by certain toxin-producing S. aureus strains in other parts of the body, such as skin, bone, and lung, and surgical wounds

Prevention and treatment

Awareness of symptoms. Prompt treatment of S. aureus infections; frequent change of tampons by menstruating women. Antimicrobial medication effective against the causative S. aureus strain; intravenous fluids

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