By Keith Roach, M.D.
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DEAR DR. ROACH: Recently, I got into a conversation with a group of friends about toxic shock syndrome. One of them claimed it is caused by synthetic menstrual products containing toxic chemicals like bleach, rayon and dioxins. I said that I’d never heard that theory before and that I thought it was because women weren’t changing their tampons often enough. No one was able to answer my next question, which was why toxic shock syndrome seems to have disappeared. I did read that the composition of tampons has since been changed and that the problem was really with a superabsorbent tampon that was taken off the market. Can you clarify this issue? — L.N.L.
ANSWER: Staphylococcal toxic shock syndrome is caused by toxins that are made by the bacteria Staphylococcus aureus, not by toxins that might be present in tampons. About half of toxic shock syndrome cases now are associated with menstruation, but it was much more common in the 1980s.
You’re right that superabsorbent tampons were shown to be associated with TSS. Their prolonged use allowed the bacteria to produce large amounts of toxin. These types of tampons were removed from the market, and women were advised to change tampons much more frequently. The rates of menstrual TSS dropped considerably. But toxic shock syndrome is not gone by any means. Keeping tampons inserted for longer than the recommended time still increases the risk of TSS, which can be severe, even life-threatening.
TSS can occur without menstruation. One common issue occurs post-surgery, with wound packing, nasal packing or even dressings serving as the location where the bacteria can grow and make the toxins that cause the syndrome.
The symptoms of TSS are rapidly developing high fever, often accompanied by lightheadedness or fainting, and skin changes, such as overall reddening of the skin followed weeks later by shedding of the outer layers of the affected skin. Multiple organs can be affected if the condition is not recognized and promptly treated.
This is a true emergency and needs to be taken very seriously by both patients and doctors. Women with these symptoms who are menstruating and using tampons should remove the tampon and seek emergency care.
DEAR DR. ROACH: My wife sweats at night to the point where she has to change her gowns two or three times, and the sheets get damp. I looked online to try and figure out why this is happening. She is 83, so it’s not change of life. She is diabetic, but her numbers are OK. Her doctor does not know why this is happening. — R.A.
ANSWER: Drenching sweats at night is a concerning symptom that needs investigation. There is a long list of possible causes, but the search for a cause starts with a very careful history and physical exam. Checking her temperature at home during these sweating episodes will be helpful.
Tuberculosis is one cause we never want to miss, and if your wife was exposed even decades ago, the infection can come back after she has gotten older, when her immune system isn’t quite what it was. Tuberculosis testing and a chest X-ray are indicated. There are other less-common chronic infections — some that are more common in specific geographic areas.
Some cancers cause night sweats, such as lymphomas. If a cause can’t be identified by a history, a CT scan might be appropriate. Thyroid disease and other hormonal conditions should be considered. You shouldn’t accept what sounds like a lack of interest from her doctor. This needs to be evaluated.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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