Medically reviewed in December 2022
When you’re having a busy day, changing your tampon can be the last thing on your mind. Waiting too long to change it, however, can lead to serious health conditions, including the potentially life-threatening toxic shock syndrome (TSS).
While there are still some cases of TSS, it’s becoming exceedingly rare. “Toxic shock syndrome happens to maybe two people out of 100,000, and only about half of those will be menstrual-related,” says Catherine Bagley, DO, an OBGYN with Henrico Doctors’ Hospital in Henrico, Virginia.
What is toxic shock?
TSS is basically a staph infection that turns potentially deadly. Staphylococcus aureus—S. aureus or staph—is a bacterium that lives on the skin or in the nose of many people. Most don’t get sick—they’re simply “colonized” by the bacteria. “Toxic shock is a staph infection that’s systemic,” meaning it affects the whole body through the bloodstream—not just the infection site, says Dr. Bagley.
Symptoms of toxic shock include:
- A widespread rash with the skin beginning to peel after a week or two
- Confusion
- Diarrhea
- Headaches
- Fever
- Redness of eyes, mouth and throat
- Nausea and vomiting
- Muscle aches and pains
- Low blood pressure
As toxic shock progresses, it can cause seizures and organ failure. Another type of bacterium—Streptococcus or strep, of strep throat fame—can also cause a condition that mimics TSS, but is much less common than staph-caused TSS, says Bagley.
Tampons and absorbency
TSS used to be more common because tampons had higher levels of absorbency, according to Bagley. “[Cases of TSS] began to decline in the 80s because most tampon companies have done away with the super-plus [absorbency] option,” she says. Highly absorbent tampons increase the risk of TSS because “the higher absorbency, the more blood is just sitting inside the vagina, which increases the risk of bacteria growing.”
Bagley says most OBGYNs recommend changing tampons every four to six hours, although some guidelines say four to eight hours. According to Bagley, doctors aren’t sure how long it takes for TSS to develop, but she said they think it depends on the type of bacteria and how it gets into the blood stream, like via a scratch or abrasion.
TSS treatment
TSS is a medical emergency. Call 911 right away if you notice any symptoms. Staph TSS has a mortality rate of 1.8 percent, but strep TSS kills 30 to 70 percent of those who get it. Treatment usually consists of antibiotics and intravenous fluids. Dialysis might be necessary if kidneys become damaged, and a treatment called immunoglobulin—medicine with a high level of antibodies that’s made from human blood—is sometimes used, as well. Those with TSS can expect to stay in the intensive care unit for some time. If you’ve gotten TSS from a tampon, you shouldn’t continue using tampons.
Other tampon issues
TSS is rare, but leaving a tampon in for too long can lead to other health issues.
“The most common result of leaving a tampon in too long is bacterial vaginosis,” says Bagley. “You run the risk of altering the normal bacterial flora in your vagina. The environment changes, one type of bacteria outgrows another and you end up with an imbalance.”
Bacterial vaginosis is the most common vaginal infection in women aged 15 to 44. It can be asymptomatic, but symptoms can include a grey discharge, odor and pain, itching or burning. Oral, topical or intravaginal antibiotics will usually clear vaginosis up in about a week.
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