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Toxic Shock Syndrome

If you're a girl who's had her period, you may have heard frightening stories about toxic shock syndrome (TSS), a serious illness originally linked to the use of tampons. But TSS isn't strictly related to tampons. The contraceptive sponge and the diaphragm, two types of birth control methods, have been linked to TSS. And, very rarely, the infection has occurred as a result of wounds or surgery, where the skin has been broken, allowing bacteria to enter.

Toxic shock syndrome can happen to anyone - men, women, and children. Although it can be serious, it's a very rare illness. If you're concerned about toxic shock syndrome, the smartest thing you can do is to read and learn about it, then take some precautions.

What Is Toxic Shock Syndrome?
TSS is a systemic illness, which means that it affects the whole body. It can be caused by one of two different types of bacteria, Staphylococcus aureus and Streptococcus pyogenes - although toxic shock that is caused by the Streptococcus bacteria is rarer. These bacteria can produce toxins - proteins that act as poisons. In some people whose bodies can't fight these toxins, the immune system reacts. This reaction causes the symptoms associated with TSS.

When people think of TSS, they often think of tampon use because the earliest cases of the illness, back in the late 1970s, were related to superabsorbent tampons. Research led to better tampons and better habits for using them - such as changing tampons more often. The number of TSS cases dropped dramatically. Today about half of all TSS cases are linked to menstruation.

Aside from tampon use, TSS has been linked to skin infections that are typically minor and are often associated with the rash of chicken pox. TSS has also been reported following surgical procedures, abortions, giving birth, and prolonged use of nasal packing for nosebleeds - although all of these are rare.

What Are the Signs and Symptoms?
Symptoms of TSS occur suddenly. Because it's an illness that is caused by a toxin, many of the body's organ systems are affected. The signs and symptoms of TSS include:

  • high fever (greater than 102 degrees Fahrenheit [38.8 degrees Celsius])
  • rapid drop in blood pressure (with lightheadedness or fainting)
  • sunburn-like rash on the entire body
  • vomiting and diarrhea
  • severe muscle aches
  • bright red coloring of the eyes, throat, and vagina
  • headache, confusion, and disorientation
  • kidney and other organ failure

The average time before symptoms appear for TSS is 2 to 3 days after an infection with Staphylococcus or Streptococcus, although this can vary depending on the cause of the infection.

Can I Prevent TSS?
The risk of TSS is already low, but you can reduce it still further by simply following some common sense precautions. Make sure you clean and bandage any skin wounds. Change bandages regularly, rather than keeping them on for several days. And be sure to check wounds for signs of infection. If a wound gets red, swollen, or tender, or if you develop a fever, call your doctor right away.

If you're a girl whose period has started, the best way to avoid TSS is to use sanitary napkins instead of tampons. For girls who prefer to use tampons, select the ones with the lowest absorbency that can handle your menstrual flow and change them frequently. You can also alternate the use of tampons with sanitary napkins. If you've already had an episode of TSS or have been infected with S. aureus, don't use tampons or contraceptive devices that have been associated with TSS (such as diaphragms and contraceptive sponges).

What Do Doctors Do?
TSS is a medical emergency. If you think you or someone you know may have TSS, call a doctor right away. Depending on the symptoms, a doctor may see you in the office or refer you to a hospital emergency department for immediate evaluation and testing.

If doctors suspect TSS, they will likely start intravenous (IV) fluids and antibiotics as soon as possible. They may get a sample for culture from the suspected site of the infection, such as the skin, nose, or vagina, and may also get a blood culture. Other blood tests can help monitor how various organs like the kidneys are working and check for other diseases that may be causing the symptoms.

Tampons or contraceptive devices should be removed, wounds should be cleaned and, if there is a pocket of infection (called an abscess), a doctor may need to drain pus from the infected area. People with TSS typically need to stay in the hospital, often in the intensive care unit, for several days to closely monitor blood pressure, respiratory status, and to look for signs of other problems, such as organ damage.

TSS is a very rare illness that's usually not fatal if recognized and treated promptly.

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