Everything you know about toxic shock syndrome is probably wrong

For a while there in the ‘90s it felt like every teen-girl magazine was required to publish at least one (terrifying) it-happened-to-me toxic shock syndrome story per year. “I left a tampon in for eight hours and almost died.” “My friend looked at a tampon once and died from TSS.” Maybe these tales were leftovers from the TSS epidemic in the late 1970s, or maybe editors tracked down new cases from actual teens. I can only assume that the intent was to make young girls aware of the dangers of toxic shock syndrome. Mission accomplished.

Now, TSS is back in the news because a model—who lost her leg to the disease in 2012—is on an awareness campaign to teach young girls about the dangers of tampons. Her story is horrifying, and is only more depressing now that she may have to have a second leg amputated. It seems all the scarier when you realize that she hadn’t even left the offending tampon in for very long (in fact, based on her telling of it, she felt ill before she put one in).

Every woman I know heard these tales as a kid and had one takeaway: we were all definitely going to get TSS if we left a tampon in for even a minute longer than the prescribed eight hours. In 9th grade I accidentally left one in for 12 hours and genuinely thought I’d narrowly escaped death. But it turns out almost everything that I and other girls my age believed about TSS is flat-out wrong. Let’s clear up a few misconceptions, starting with the basics.

Could you remind me ahem, my friend what TSS actually is?

Don’t be embarrassed. I would venture a guess that most folks don’t really know what TSS is, besides “a horrifying disease that you get from tampons.”

Toxic shock syndrome isn’t really a disease in and of itself. It’s a complication of a bacterial infection. There are two kinds of bacteria, staphylococcus aureus and group A streptococcus, that can produce a toxin called TSST-1 (toxic shock syndrome toxin 1). TSST-1 is a superantigen, which means it prompts the immune system to massively overreact to an infection. The resulting storm of immune cells causes the body to go into shock as inflammation spreads and a fever rises, and if left unchecked will eventually cause multi-organ failure. And the toxin can enter the bloodstream even if the bacteria are isolated to one area, so an infection in a single part of the body can end up killing you. Other toxins can also cause TSS, but TSST-1 is the most common one for tampon-related cases.

TSS is actually really rare

In 2016, the CDC reported a grand total of 323 cases. That’s not insignificant, but is pretty tiny when you consider that there are roughly 63 million women between the ages of 15 and 44 in the United States. That’s a rate of 0.0005 percent. Even fewer people died of it that year—just 26 men and women. This isn’t to minimize those losses, because for the victims and their families, TSS was devastating. But on the spectrum of possible causes of death to worry about, toxic shock syndrome is exceedingly unlikely.

Read more at: https://www.popsci.com/toxic-shock-syndrome#page-2