Tampons & Toxic Shock Syndrome

What’s the connection?

By Sylvie Arvanitakis

Feeling like she may have contracted the flu, all Lauren Wasser wanted to do on the night of October 3, 2012 was collapse into bed. The next day paramedics found the 24-year-old unconscious in her bathroom with a fever of 41.7 C. She had suffered a massive heart attack and her organs were shutting down. The tampon she was wearing when she was brought to an emergency room tested positive for toxic shock syndrome (TSS).

After Vice Media published a story about Lauren last summer – a story that also recounted the loss of her left leg below the knee and the toes on her right foot due to her infection turning gangrenous – women were once again weighing the convenience versus the risks of tampon use. TSS is a rare illness but what happened to Lauren is a chilling reminder about what makes it so dangerous: initial symptoms are easy to dismiss and the consequences can escalate rapidly if left untreated.

TSS is a potentially fatal disease caused by toxins entering the bloodstream after a bacterial infection. The bacteria mostly associated with TSS are Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (this form is often referred to as toxic shock-like syndrome or streptococcal toxic shock syndrome). Tampon-related TSS is caused by a strain of S. aureus that produces the toxin TSST-1. Once in the blood it can cause the immune system to go into overdrive, and harm instead of heal.

Tampons alone do not cause TSS, but they can react with S. aureus to create an environment for bacteria to flourish. TSS and tampons have been linked since the early’80s when the majority of the thousands of cases reported in the US during that time were found to be women using highly absorbent tampons. The incidence of TSS in women using tampons has declined sharply since, due in large part to changes in manufacturing materials and public awareness.

To develop TSS a woman must already have the toxigenic strain of S. aureus present in her vagina and lack the antibodies for TSST-1. A 2005 study of North American women in the Journal of Clinical Microbiology showed that only one percent carried the strain and that the majority had antibodies to the toxin. Women who have been diagnosed with TSS in the past have a very high risk (as much as 30 percent) of recurrence.

TSS is treatable if caught early. If you or someone you know is experiencing symptoms ensure the tampon is removed (keep for testing), and then get medical attention immediately. Tell the treating healthcare professional that a tampon was used when the symptoms began.

  • Fever greater than 38.9°C
  • Sudden drop in blood pressure/dizziness/fainting
  • Disorientation
  • Vomiting/diarrhea
  • Muscle pain
  • Rash that resembles a sunburn


  • Don’t use tampons until your period begins
  • Wash your hands before and after handling a tampon
  • Use the lowest absorbency necessary
  • Change your tampon every 4-8 hours
  • Alternate between tampons and pads
  • Don’t leave a tampon in overnight
  • Don’t use tampons if you have been previously diagnosed with TSS


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