The relationship of tampon characteristics to menstrual toxic shock syndrome

The pathogenic basis for the association of tampons with toxic shock syndrome (TSS) has not been explained adequately. Absorbency and chemical composition of tampons are related, and no prior study has had a sufficient number of cases to evaluate these independently as risk factors for disease. We compared national TSS passive surveillance data on the 285 tampon-associated menstrual cases of TSS reported from 1983 to 1984 with data on age- and year-matched controls from national surveys of tampon usage. Users of all brands of tampons had elevated risks when compared with non-tampon users (odds ratio, 32.8; 95% confidence interval, 15.5, 69.6). Regardless of the chemical composition of the tampon, increasing absorbency increased the odds ratio for TSS. Chemical composition also influenced odds ratios. Polyacrylate-containing tampons had odds ratios that were elevated but, once controlled for absorbency, that were lower than the odds ratios for cotton, rayon, and cotton/rayon tampons. The strong association of absorbency with risk of illness would suggest that as a public health measure the use of a low-absorbency tampon is likely to reduce the risk of TSS in the user.