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Type of TSS striking men, nonmenstruating women

Lauri Githens Hatch Rochester (N.Y.) Democrat and Chronicle

A tampon-linked illness dating to the Reagan era resurfaced in a troubling study last summer – but few knew about it, for as fate would have it, the study came out almost the very week the former president died.

Lost in a sea of tributes and funeral coverage was this:

Toxic shock syndrome, or TSS, which by 1980 had sickened hundreds, killed several dozen and been linked to highly absorbent tampons, is showing up again. But that isn’t all.

There has been a surge in a highly virulent “cousin” type of TSS – toxic strep syndrome – affecting men and nonmenstruating women much the way tampon-related cases do.

What’s the difference?

Tampon-linked TSS cases start with staphylococcus aureus bacteria, creating bloodstream toxins in the pH-neutral environment of the vagina during menstruation.

The other TSS cases start with streptococcus pyogenes bacteria, creating bloodstream toxins in the pH-neutral environment of cuts, surgical wounds, illness-weakened tissue, or the uterus after childbirth.

Because both bacteria produce toxins that zip past the body’s immunities, resist antibiotic treatment and swiftly wreak havoc with symptoms including fever, chills, nausea, vomiting and sometimes kidney and heart failure, both types of TSS – staph- and strep-based – have the medical community deeply worried.

Though he’d been tracking toxic bacteria illnesses for 20 years, University of Minnesota researcher Patrick Schlievert reported in the June 2004 Journal of Clinical Microbiology on an alarming trend: Between 2000 and 2003, there’d been a spike in TSS cases from 15 to 50, “and what’s worrying is, only half these cases are menstrual,” he says.

While not downplaying the resurgence of menstrual cases, Schlievert wishes more people knew of, and paid attention to, the streptococcal form of TSS. More than half of those who get strep TSS die, according to the Centers for Disease Control and Prevention.

If the bacteria (which in a noninvasive form causes milder illnesses such as strep throat), gets into skin this way, conditions are ripe for toxins to possibly kill. The 1990 death of Muppets creator Jim Henson, from a toxic streptococcal-induced pneumonia, highlighted this. “I’m very worried about these because those lung cases can be 60 to 80 percent fatal, if they’re really proving antibiotic-resistant,” Schlievert adds.

Staph strains capable of causing menstrual TSS also are reemerging.

Teen girls having intercourse earlier than those 25 to 30 years ago can tolerate larger tampons, and they may wear them longer during a busy school day when even lunch breaks aren’t guaranteed.

That combination, Schlievert agrees, creates a condition ripe for TSS.

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