Toxic Shock Syndrome Associated with the Use of Menstrual Products

Toxic shock syndrome, or TSS, is an illness caused by the Staphylococcus aureus and Streptococcus pyogenes bacterias. It is a rare yet serious illness most commonly found in cases of intravaginal products being used for the menstrual cycle that introduce these bacteria to the body. The bacteria grow in the vagina, producing the toxic shock syndrome toxin 1 (TSST-1) (El Soufi et al., 2021). Tampons are the leading menstrual product which cause TSS, but there have also been cases reported of menstrual cups causing TSS as well. I chose the course objective “know the structure and function of reproductive organs” for my project, since I was interested in toxic shock syndrome specifically associated with the use of menstrual products. TSS has also been found in cases not caused by menstrual products, when the same type of bacteria enter the body and cause illness, but these cases are more rare. However, it is important to note that they occur because TSS can happen to anyone, not just those who menstruate.

Intravaginal menstrual products, such as tampons and menstrual cups, are generally safe to use. It is when tampons are super-absorbent and/or left in the vagina too long (eight hours is the recommended maximum amount of time to avoid risk of TSS), and when menstrual cups are not properly cleaned, that bacteria has a greater chance to grow in the vagina. Once bacteria has grown and produced the TSST-1 toxin, it leads to life-threatening illness and possible death. The toxin TSST-1 acts as a “superantigen” and activates 30% of host T cells, which is an excessively large amount. In turn, large amounts of cytokine (proteins released by immune cells) trigger a large immune response. TSS is often characterized by hypotension, fever, rash, tachycardia and multiorgan failure, which can lead to death. Warning signs of menstrual TSS include vomiting, fever, dizziness, rash and abdominal cramping, as well as other irregular symptoms which occur while and/or after menstruating (Mitchell et al., 2015).

In a study conducted by Nonfoux et al. in 2018, it was found that there was slightly higher growth of S. aureus and toxin production with menstrual cups than tampons. This was theorized to be due to the greater amount of air which menstrual cups introduce to the vagina. Using smaller menstrual cups is encouraged in order to decrease the possibility of toxin growth with a menstrual cup. In addition, menstrual cups should be boiled to ensure proper sanitation and kill off TSS-causing bacteria. Using the proper sanitation methods of menstrual cups, and proper absorbency level of tampons can help avoid developing TSS. 

Toxic shock syndrome was first given the moniker in 1978 to describe a complex illness found in children characterized by an acute fever. TSS was then found to be linked with the use of tampons in young women in 1980 (Mitchell et al., 2015). In 1980, the highest number of menstrual TSS cases were reported, 813 cases, which included 38 deaths. These TSS cases were found linked to special highly absorbent tampons, which triggered the withdrawal of super absorbent tampons from the market in 1980. After that, the cases of TSS drastically decreased with only six cases being reported in 1997, and those numbers remaining low today (Meadows, 2000). 

With my STEAM project drawing, I depicted a body being slowly covered by green “toxic sludge,” with the rest of the body being colored grey to indicate that it is not healthy. A toxicity warning label sign is in the place where the uterus would be, with a red tampon visible inside. The string of the tampon hangs down long, and is connected with green and orange color fibers which are also meant to indicate toxicity. My thinking around the piece is to show how a tampon can be something toxic to the body, and to use the idea of toxic waste to show how the body is being affected by the bacteria introduced by the tampon.

References

El Soufi, H., El Soufi, Y., Al-Nuaimi, S., & Bagheri, F. (2021). Toxic shock syndrome associated with menstrual cup use. IDCases, 25, e01171. https://doi.org/10.1016/j.idcr.2021.e01171

Meadows, M. (2000). Tampon Safety. FDA Consumer, 34(2), 20. 

Mitchell, M. A., Bisch, S., Arntfield, S., & Hosseini-Moghaddam, S. M. (2015). A Confirmed Case of Toxic Shock Syndrome Associated with the Use of a Menstrual Cup. Canadian Journal of Infectious Diseases and Medical Microbiology, 26(4), 218–220. https://doi.org/10.1155/2015/560959

Nonfoux, L., Chiaruzzi, M., Badiou, C., Baude, J., Tristan, A., Thioulouse, J., Muller, D., Prigent-Combaret, C., & Lina, G. (2018). Impact of Currently Marketed Tampons and Menstrual Cups onStaphylococcus aureusGrowth and Toxic Shock Syndrome Toxin 1 ProductionIn Vitro. Applied and Environmental Microbiology, 84(12), e00351-18. https://doi.org/10.1128/aem.00351-18