Recurrent menstrual toxic shock syndrome with and without tampons in an adolescent

Women's attitudes toward certification logos, labels, and advertisements for organic disposable sanitary pads: results from a multi-city cross-sectional survey

BACKGROUND

This cross-sectional study evaluated women's attitudes toward the certification logos, labels, and advertisements for organic disposable sanitary pads (OSPs) and investigated what could be the main reason for them. Additionally, the present study examined whether a relationship could be found between these attitudes and OSPs purchasing behavior.

METHODS

This study was conducted using a self-reported online survey of Korean adult women who have purchased OSPs. The study questionnaire had four sections, covering (1) characteristics of OSP purchasing behavior, (2) attitudes toward OSP certification logos, labels, and advertisements, (3) demand on government and companies for proper management, and (4) respondent's sociodemographic information. The Cronbach's alpha value of the questionnaire was 0.857.

RESULTS

A total of 500 respondents completed the questionnaire. Overall, high reliability was found for the certification logos (3.73 ± 0.61), labels on the product packaging (3.71 ± 0.63), and advertisements of OSPs (3.41 ± 0.62). Respondents indicated that these had fairly positive effects on their decision-making regarding product reliability, product image, and their own purchasing behavior. The aspects most frequently affected from the informants were safety to human health. All attitudes toward OSP certification logos, labels, and advertisements that were evaluated in this study became more positive in the direction from non-buyers to occasional buyers and to habitual buyers (all P < 0.05). The most significant demand from the respondents for OSP companies and the government was to clearly indicate hazardous ingredients on the OSP packaging (42.0%) and to strengthen the sanctions for false advertising (37.8%), respectively.

CONCLUSIONS

The results of this study clearly indicate the importance of using certification logos, labels, and advertisements in the OSP market. These results can be utilized by OSP companies to improve the effectiveness of their marketing strategies or by policy makers and certifying bodies to manage the informants properly in the OSP market.

Menstrual toxic shock syndrome: a French nationwide multicenter retrospective study

BACKGROUND

Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking.

METHODS

This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between January 1, 2005 and December 31, 2020 in 43 French pediatric (n=7) or adult (n=36) ICUs. The aim of the study was to describe the clinical features and short-term prognosis, as well as assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, of critically ill patients with m-TSS.

RESULTS

In total, 102 patients with m-TSS (median age: 18 [16-24] years) were admitted to one of the participating ICUs. All blood cultures (n=102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for super-antigenic toxin gene sequences was performed for 76 of the 92 (83%) vaginal samples positive for Staphylococcus aureus and TSST-1 isolated from 66 (87%) strains. At ICU admission, no patient met the 2011 CDC criteria for confirmed m-TSS and only 53 (52%) fulfilled the criteria for probable m-TSS. Eighty-one patients (79%) were treated with anti-toxin antibiotic therapy and eight (8%) received intravenous immunoglobulins. Eighty-six (84%) patients required vasopressors and 21 (21%) tracheal intubation. No patient required limb amputation or died in the ICU.

CONCLUSIONS

In this large multicenter series of patients included in ICUs for m-TSS, none died or required limb amputation. The CDC criteria should not be used for the clinical diagnosis of m-TSS at ICU admission.

Use of Menstrual Sanitary Products in Women of Reproductive Age: Korea Nurses' Health Study

OBJECTIVES

The use of menstrual hygiene products and its effect on women's health remains under studied. Patterns of menstrual hygiene product use and the rationale behind choices among Korean women aged 18-45 years were examined.

METHODS

This cross-sectional study was a part of the Korea Nurses' Health Study. A total of 20,613 nurses participated, and 8,658 nurses participated in Module 7 which included a menstrual hygiene products-related survey. The data were collected through the mobile survey using a self-reported questionnaire. Participants' use of menstrual hygiene products and related characteristics were analyzed using frequency (percentage) or mean (SD).

RESULTS

The most common types of menstrual hygiene products across all age groups were disposable menstrual pads (89.0%), followed by cloth menstrual pads (4.5%), tampons (4.2%), and only 1.6% used a menstrual cup. Disposable menstrual pads were the most common across all age groups, but in those aged under 30 years this was followed by tampon use (6%). The most important criteria when choosing a menstrual hygiene product was comfort for disposable menstrual pads (31.3%) and tampons (41.5%), natural ingredients or organic products for cloth menstrual pads (51.4%), and custom fit for the menstrual cup (50.7%). However, for all menstrual hygiene products (except cloth menstrual pads), there was a higher proportion of anxiety than perception of safety, and low awareness of toxic shock syndrome.

CONCLUSION

It is important for women to use menstrual hygiene products with confidence. More research is needed to better understand potential health effects of menstrual hygiene products.

Toxic Shock Syndrome: Still a Timely Diagnosis

BACKGROUND

Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has made headlines because of its high associated morbidity and mortality rate in previously healthy young females. Incidence peaked in the early 1980s owing to increased usage of ultra-absorbent tampons. After improved patient education and tampon labeling, the incidence of menstrual TSS has declined.

CASE

A previously healthy 14-year-old girl presented to an urgent care center with a 2-day history of fever, erythematous maculopapular rash, vomiting, diarrhea, and malaise. She was found to be tachycardic and hypotensive. Investigations revealed thrombocytopenia, an elevated white count and lactate, and acute kidney injury, consistent with septic shock. Recent tampon usage with menstruation was reported, and a pelvic examination revealed purulent vaginal discharge. The patient was transferred to a pediatric intensive care unit for antibiotic and vasopressor therapy. Vaginal swabs later tested positive for Staphylococcus aureus and TSS toxin-1.

CONCLUSIONS

Although the incidence of TSS has decreased in recent years, it is crucial that clinicians rapidly recognize and treat this life-threatening condition. Emergency physicians should always have a high index of suspicion for TSS in young females presenting without another obvious cause of shock. A pelvic examination should always be completed in these cases.

Menstrual toxic shock syndrome: case report and systematic review of the literature

Menstrual toxic shock syndrome (mTSS) is a life-threatening disease caused by superantigen-producing Staphylococcus aureus. Incidence ranges from 0·03 to 0·50 cases per 100 000 people, with overall mortality around 8%. In this Grand Round, we present the case of a previously healthy 23-year-old menstruating woman who was diagnosed with mTSS after she presented at our hospital with a septic condition for the second time. The diagnosis was confirmed by fulfilment of the clinical criteria outlined by the US Centers for Disease Control and Prevention (CDC; fever, rash, desquamation, hypotension, and multi-system involvement) as well as a nasal swab positive for the S aureus strain and presence of the gene encoding for toxic shock syndrome toxin 1 (TSST-1). In the early 1980s, when mTSS was first described, use of tampons was considered the main risk factor. Today, the complex interplay between pathogenic factors of S aureus, immunological mechanisms of the host, and changes in the vaginal ecosystem during menstruation has broadened current understanding of the disease, and the CDC criteria have appreciable limitations in everyday clinical practice.

A confirmed case of toxic shock syndrome associated with the use of a menstrual cup

Toxic shock syndrome (TSS) is caused by toxic bacteria and has been associated with prolonged, continual use of high-absorbency tampons. This article documents the first case of TSS associated with the use of a menstrual cup in a 37-year-old woman. The authors also discuss the history of TSS associated with tampon use and the mechanisms by which menstrual cups may also lead to the syndrome.

Menstrual cups have been reported to be an acceptable substitute for tampons. These flexible cups have also been reported to provide a sustainable solution to menstrual management, with modest cost savings and no significant health risk.

The present article documents the first case of toxic shock syndrome associated with the use of a menstrual cup in a woman 37 years of age, using a menstrual cup for the first time. Toxic shock syndrome and the literature on menstrual cups is reviewed and a possible mechanism for the development of toxic shock syndrome in the patient is described.