Toxic Shock Syndrome Explained: As Model Loses Leg, We Explore What Really Causes TSS

Lauren Wasser was just 24 years old when she was rushed to hospital with a fever of 107 degrees. Just ten minutes from death, her internal organs were shutting down and she'd suffered a heart attack.

As doctors frantically tried to stabilise her, nobody seemed to know what exactly was wrong. It was only after an infectious disease specialist asked if she had a tampon in that something clicked.

The tests that followed revealed the worst - Wasser had toxic shock syndrome (TSS).

Now, the LA-based model is suing the tampon brand Kotex which, she claims, was to blame for her contracting the rare condition and losing a leg.

Many women will have heard about TSS at some point in their lives - after all, anyone who's read the instructions on a tampon packet with be familiar with the term - however a lot of people don't actually know that much about it (doctors included).

Toxic shock syndrome is a bacterial infection caused by Staphylococcus aureus and Streptococcus pyogenes bacteria.

Usually, these bacteria live harmlessly on the skin, nose or mouth but can invade the body's bloodstream and release poisonous toxins, which also damage tissue, including skin and organs, and can disturb many vital organ functions.

This fact becomes even more disconcerting when you think about how much time a woman will actually spend with a tampon inserted in her vagina - to put this into perspective for you, the average woman will be on her period for an average of six to seven years during her life.

According to the NHS, a significant proportion of TSS cases occur in women who are on their period and using a tampon. There are roughly 40 cases of the condition reported each year in the UK, half of which are associated with tampon use.

But Tracy Stewart, director of the Absorbent Hygiene Products Manufacturers Association (AHPMA) - an independent body that carries out research on items such as tampons, nappies and incontinence pads - says that "there's no proven link between tampon use and toxic shock syndrome" and that it can actually affect anyone.

"What we do know is that women should be aware of this in relation to any internally-worn device," she adds. "We know that there are cases related to internal contraception, we know there are cases associated with child birth and so it's wrong to say that one type of product can cause this."

She also highlights that statistics surrounding the condition aren't particularly reliable.

"It can affect anybody: men, women, children," says Stewart. "Unfortunately you often hear of very young children getting toxic shock syndrome, for example, when they've had a very minor scold or burn. Or even from a chicken pox spot that's become infected."

She adds: "People tend to think they've got something like the Novovirus or gastroenteritis. You get flu-like symptoms and experience muscle aches, cramps, dizziness, chronic nausea and diarrhoea.

"Sometimes you'll get a rash that pops up and goes, a high fever, and the thing that denotes it as being toxic shock syndrome is a drop in blood pressure.

"That's a very important symptom to watch out for as it can tell a doctor that there's shock going on. So it's really important that blood pressure is taken - particularly in children."

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Due to the lack of research and statistics surrounding toxic shock syndrome, more and more questions are now being raised surrounding the condition itself, alongside tampon usage in general.

In a piece for the Guardian, Congresswoman Carolyn Maloney argued that not enough is known about whether tampons are safe to use over a long period of time.

She wrote: "The average woman who uses tampons will use over 16,800 during the course of her lifetime – and there is almost no data on the health effects of the cumulative use of tampons over a woman’s lifetime."

So are they safe?

Nowadays, tampons are made from a "natural cellulosic absorbent material", which is often rayon or cotton or a mixture of both. And to make them easy-to-insert (while also reducing the loss of fibres) they are covered with a non-woven or perforated film.

A study on tampon safety published on the National Center For Research suggested that tampons might not be that safe to use.

Rayon is a synthetic fibre which is made from wood pulp and during the manufacturing process, a toxic byproduct called dioxin is created. According to researchers, a very small amount of dioxin can be found in rayon fibre.

The WHO states that dioxins are "highly toxic" and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and also cause cancer.

In trials where monkeys were exposed to dioxins, they were found to have an increased risk (80%) of developing endometriosis - which occurs when uterine tissue is found outside of the uterus and can sometimes cause infertility.

Of course, small traces of dioxin are found in tampons and, scientists argue that this isn't really an issue. But if they're used again and again over half of a woman's lifetime, then could it impact her health?

"Because of that, we conduct ongoing safety evaluations of our tampons and we regularly review our safety information with independent experts, physicians, nurses, and scientists to assure our products can be used with confidence."

The jury's out.