Menstrual Disorders: TSS

Question 1

Menstrual TSS

Answer 1

• Primarily affects young patients 13-19 years old
• Increased risk with: TAMPONS
• Inflammatory response to enterotoxins produced by Staphylococcus aureus

Question 2

TSS Clinical Presentation

Answer 2

• Prodromal symptoms 2-3 days before onset
- Malaise, myalgias, chills, vomiting, diarrhea, and abdominal pain

• Evolves quickly
- High fever, myalgias, severe vomiting and diarrhea, erythroderma, decreased
urine output, severe hypotension, and shock
- Neurologic manifestations (headache, confusion, agitation, lethargy, seizures)
- Acute renal failure, cardiac involvement, adult respiratory distress syndrome

• Dermatologic manifestations are characteristic
• Early rash
• Skin sloughs off after 5-12 days on face, trunk, extremities

Question 3

Prevention of TSS

Answer 3

• Use sanitary pads instead
• If must use tampons:
• Use lowest-absorbency
• Alternate with pads (e.g., use pads at night)
• Change 4-6x a day at least q6h, overnight use <8 hours
• Wash hands before inserting anything into vagina
• Do not leave in vagina longer than recommended nor during menstruation
• Do not use during 12 weeks after childbirth; may also be best to avoid diaphragm
• Patients with sx of TSS should remove tampon or device immediately and seek emergency care
• Patients with history of TSS are at risk for recurrence; avoid tampons, IUCs, diaphragms, caps, sponges

Question 4

Alternative Products for Menstruation

Answer 4

• Menstrual cups (latex or silicone) – low risk of TSS
• Organic tampons
• Sea sponge tampons
• Absorptive, reusable, washable underwear
• Organic, bleach-free pads
• Reusable pads