Overview
Introduction
Gynecologic toxic shock syndrome (TSS) is a rapidly progressive toxin mediated emergency.
Gynecologic toxic shock syndrome (TSS) is a rapidly progressive toxin-mediated emergency. In menstrual cases, vaginally colonizing Staphylococcus aureus may produce toxic shock syndrome toxin-1 (TSST-1). The toxin cross-links MHC class II molecules on antigen-presenting cells with the T-cell receptor Vbeta domain outside the usual antigen-binding groove. This activates a large fraction of T cells at once, producing a cytokine surge, capillary leak, vasodilation, hypotension, and multiorgan dysfunction. A tampon, menstrual cup, contraceptive sponge, diaphragm, cervical cap, vaginal packing, or IUD may provide the setting for toxin production, but colonization alone does not cause disease. TSS can also occur after gynecologic surgery, during the postpartum period, or with a wound or necrotic lesion. The practical nurse should treat abrupt fever with gastrointestinal symptoms, rash, poor perfusion, or altered mentation as an emergency pattern rather than waiting for culture confirmation.