If you’ve ever read the little instructions pamphlet included in a box of tampons, you probably came across a paragraph calling attention to a condition called toxic shock syndrome (TSS). It describes the association between TSS and tampon use, symptoms of TSS, and guidance on how to reduce risk. This legally mandated warning label has formed an indelible link connecting tampons and TSS, and indeed, tampons form a large part of the story of TSS. But they are not the entire story. In this episode, we delve into that full story, examining what TSS actually is, the pathogens it’s associated with, and how it was first identified. If you’ve had TSS questions ever since you first heard of it in health class or on your box of tampons, this is the episode for you!
| History | Biology |
| Vostral, Sharra L. “Toxic shock: A social history.” Toxic Shock. New York University Press, 2018. | Berger, S., Kunerl, A., Wasmuth, S., Tierno, P., Wagner, K. and Brügger, J., 2019. Menstrual toxic shock syndrome: case report and systematic review of the literature. The Lancet Infectious Diseases, 19(9), pp.e313-e321. |
| Centers for Disease Control: Toxic-shock syndromeUnited States. Morbid Mortal Weekly Rep 29:229-230, May 23, 1980. | Reame, N.K., 2020. Toxic shock syndrome and tampons: The birth of a movement and a research ‘Vagenda’. The Palgrave handbook of critical menstruation studies, pp.687-703. |
| Centers for Disease Control: Follow-up on toxic-shock syndrome-United States. Morbid Mortal Weekly Rep 29:297-299, June 27, 1980. | Schlievert, P.M. and Davis, C.C., 2020. Device-associated menstrual toxic shock syndrome. Clinical Microbiology Reviews, 33(3), pp.10-1128. |
| Dan, Bruce B. “Toxic shock syndrome: Back to the future.” JAMA 257.8 (1987): 1094-1095. | Lappin, E. and Ferguson, A.J., 2009. Gram-positive toxic shock syndromes. The Lancet infectious diseases, 9(5), pp.281-290. |
| Davis, Jeffrey P., et al. “Toxic-shock syndrome: epidemiologic features, recurrence, risk factors, and prevention.” New England Journal of Medicine | Atchade, E., De Tymowski, C., Grall, N., Tanaka, S. and Montravers, P., 2024. Toxic Shock Syndrome: a literature review. Antibiotics, 13(1), p.96. |
| Hanrahan, Susan Noll, and Haworth Continuing Features Submission. “Historical review of menstrual toxic shock syndrome.” Women & health 21.2-3 (1994): 141-165. | Silversides, J.A., Lappin, E. and Ferguson, A.J., 2010. Staphylococcal toxic shock syndrome: mechanisms and management. Current infectious disease reports, 12, pp.392-400. |
| Petitti, Diana B., Arthur Reingold, and James Chin. “The incidence of toxic shock syndrome in Northern California: 1972 through 1983.” JAMA 255.3 (1986): 368-372. | Burnham, J.P. and Kollef, M.H., 2015. Understanding toxic shock syndrome. Intensive care medicine, 41, pp.1707-1710. |
| Todd, James, et al. “Toxic-shock syndrome associated with phage-group-I Staphylococci.” The Lancet 312.8100 (1978): 1116-1118. | Neumann, C., Kaiser, R. and Bauer, J., 2020. Menstrual cup-associated toxic shock syndrome. European Journal of Case Reports in Internal Medicine, 7(10), p.001825. |
| Tofte, Robert W., and David N. Williams. “Toxic shock syndrome: evidence of a broad clinical spectrum.” JAMA 246.19 (1981): 2163-2167. | DeVries, A.S., Lesher, L., Schlievert, P.M., Rogers, T., Villaume, L.G., Danila, R. and Lynfield, R., 2011. Staphylococcal toxic shock syndrome 2000–2006: epidemiology, clinical features, and molecular characteristics. PloS one, 6(8), p.e22997. |
| Hajjeh, R.A., Reingold, A., Weil, A., Shutt, K., Schuchat, A. and Perkins, B.A., 1999. Toxic shock syndrome in the United States: surveillance update, 1979-1996. Emerging infectious diseases, 5(6), p.807. | |
| Sharma, H., Smith, D., Turner, C.E., Game, L., Pichon, B., Hope, R., Hill, R., Kearns, A. and Sriskandan, S., 2018. Clinical and molecular epidemiology of staphylococcal toxic shock syndrome in the United Kingdom. Emerging Infectious Diseases, 24(2), p.258. | |
| Nelson, G.E., Pondo, T., Toews, K.A., Farley, M.M., Lindegren, M.L., Lynfield, R., Aragon, D., Zansky, S.M., Watt, J.P., Cieslak, P.R. and Angeles, K., 2016. Epidemiology of invasive group A streptococcal infections in the United States, 2005–2012. Reviews of Infectious Diseases, 63(4), pp.478-486. | |
| Billon, A., Gustin, M.P., Tristan, A., Bénet, T., Berthiller, J., Gustave, C.A., Vanhems, P. and Lina, G., 2020. Association of characteristics of tampon use with menstrual toxic shock syndrome in France. EClinicalMedicine, 21. | |
| Vostral, S., 2017. Toxic shock syndrome, tampons and laboratory standard–setting. CMAJ, 189(20), pp.E726-E728. | |
| Cowart, L. 2016. Women are still getting Toxic Shock Syndrome, and no one quite knows why. Washington Post. https://www.washingtonpost.com/news/speaking-of-science/wp/2016/03/21/women-are-still-getting-toxic-shock-syndrome-and-no-one-quite-knows-why/?noredirect=on/?variant=d846d44221ecba95 | |
| CDC NNDSS Summary Data 2016-2022. https://wonder.cdc.gov/nndss-annual-summary.html |
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