For many of us period-having folk, Toxic Shock Syndrome (TSS) is something that's always in the back of our minds... I think I may have left my tampon in too long - will I get TSS? I'm feeling a bit light-headed - do I have TSS?

Statistically speaking, TSS is not super common (it occurs in around one in a million, literally); so whilst it is a very rare disease, it can also be life-threatening. Here's what you need to know and how you can minimise your risk.

WHAT IS TOXIC SHOCK SYNDROME (TSS)?

TSS is a very rare but very serious disease that's caused by an infection with certain bacteria (most commonly Staphylococcus Aureus, also known as Staph - or more rarely, Group A Streptococci, also known as Strep), making their way into the body and releasing harmful toxins into the bloodstream, which can  in turn affect your organs.

WHO IS AT RISK OF TSS?

Literally anyone of any age! Toxic Shock Syndrome is most commonly associated with people who menstruate and use tampons, but anyone with a Staph or Strep infection can also potentially develop TSS; including people who don't menstruate, or who don't use tampons or period cups. Even children are at risk.

WHAT CAUSES TOXIC SHOCK SYNDROME?

Whilst tampon use has been associated with an increased risk of TSS (more on that in a bit), the root cause of TSS is actually from an over-growth of bacteria - usually Staph (or more rarely, Strep) that can even stem from a cut on your skin or a wound that has become infected. 

These bacteria are commonly found in the nose of about one third of the population but can also be found on the skin and occasionally in the vagina - without causing harm. But in some circumstances, these bacteria can overgrow and can release harmful toxins into the body, causing infection.

WHAT ARE THE SYMPTOMS OF TOXIC SHOCK SYNDROME?

Early TSS symptoms might come on quite suddenly and feel a bit like the flu. They can also get worse very quickly. Here's what to look out for:

• High fever and chills (usually 39°C or 102°F, or higher)
• Headache 
• Flu-like symptoms (like an aching body, sore throat and a cough)
• Vomiting, diarrhoea, or both (yikes!)
• Faintness, dizziness/confusion or weakness
• A drop in blood pressure
• A sun-burn like rash
• Difficulty breathing
• Joint pains

If you think you have TSS, see a Doctor or go to the ER immediately.

DO TAMPONS CAUSE TSS?

Put simply, no. Tampons are not sterile and neither are your hands or vagina. And so, whilst containing very small amounts of bacteria normally present in the air, tampons themselves have not been shown don't carry the bacteria that causes TSS.

That said, tampon use has been associated with an increased risk. It's understood that in some rare circumstances, the presence of a blood-absorbed tampon may cause these bacteria to over-grow in the vagina (read on for tips on how tampon users can minimise their risk of TSS).

CAN YOU GET TSS FROM MENSTRUAL CUPS?

Menstrual cups carry the same risks associated with TSS as tampons do, so it's important to sanitise your cup before use and remove it at least every 8 hours (you can rinse and re-insert as you need to). Only use your cup whilst you're menstruating. Unlike tampons, the size of the period cup or the amount of flow it holds has no bearing on your risk of TSS.

CAN YOU GET TSS FROM PADS OR PERIOD UNDERWEAR?

Remember, anyone can get TSS, as TSS is caused by bacteria. So even if you use pads or period underwear, you are still at risk of developing an infection, but the thing to remember here is that pads or period underwear themselves won't cause TSS. The use of products like pads and period underwear aren't specifically linked to instances of Toxic Shock Syndrome as commonly as tampons have been, as far as we're aware, but it's still important to practice good intimate care and hygiene to help minimise your risk of infection. See your Doctor if you feel anything is amiss after using these products.

WHOW LONG DOES TSS TAKE TO SET IN?

According to WebMD, TSS symptoms usually display themselves pretty quickly (see above for what to look out for) and will set in around 2 days after the bacteria infects you. If you think you have TSS, see a Doctor or go to the ER immediately.

CAN YOU STILL GET TSS EVEN AFTER A TAMPON IS REMOVED?

Yes it's possible, as TSS is caused by bacteria, not tampons themselves. It may or may not be the presence of a tampon that has caused an instance of TSS.

IS TSS CONTAGIOUS?

Toxic Shock Syndrome is caused by a bacterial infection (not a virus) and so it can't be transmitted from person-to-person. 

HOW TO REDUCE YOUR RISK OF TSS (ESPECIALLY IF YOU'RE A TAMPON USER)

• Be sure to only use the lowest possible absorbency tampon for your flow.
• Be sure to change your tampon or menstrual cup at least every 4 - 6hrs (this may vary depending on your flow, but don't leave it in for more than 8hrs at a time).
• We recommend wearing a pad at night instead of a tampon or a period cup - this is because tampons should not be worn for any longer than 8hrs at a time and if you happen to over-sleep, you may miss this window. 
• Wash your hands before handling and using a tampon or cup (only unwrap and use it when you need it).
• If using a tampon, be sure to remove the one inside you before inserting a new one.
• If using a cup, be sure to remove and rinse it in clean water at least every 8hrs.
• Only use tampons and cups when you have your period.
• If you're recently given birth, have had a C-section, a miscarriage or an abortion, or if you have had an operation on your reproductive system, check with your Doctor before using tampons or cups.

You may also consider using another form of period management, like pads instead of tampons or cups - though this won't necessarily negate your risk of getting TSS from other unrelated circumstances.

Whether or not you do or don't experience a period, a bacterial infection can still set in and trigger TSS - so if you notice any sign of infection, swelling or redness around a cut or wound anywhere on your body, GET CHECKED!

WHAT TO DO IF YOU THINK YOU HAVE TSS

See a Doctor immediately. If your symptoms are severe or if they are rapidly getting worse, call for an ambulance or go to the nearest emergency room.

If you're wearing a tampon, menstrual cup or a diaphragm, also remove it immediately (and be sure to tell your Doc if you've been using one).

TSS is a medical emergency and should be treated like one - and so whilst it's probably unlikely that you have TSS, please don't ignore your symptoms! It's always best to get checked. Early detection means earlier treatment.