Staphylococcal menstrual toxic shock syndrome. Tampon toxic shock syndrome: symptoms, treatment. Who is at risk

TOXIC SHOCK SYNDROME honey.
Syndrome toxic shock- staphylococcal endotoxin infection that develops during infection with strains that produce the TSST-1 toxin (toxic shock syndrome toxin-1) and, less commonly, enterotoxins B and C. Epidemiology. The lesion was first registered in 1980 in women 15-25 years of age who used sorbent tampons during menstruation (after the advent of tampons with reduced sorbent properties and without polyacrylic fillers, the incidence of septic shock decreased sharply). The syndrome can also develop after childbirth and as a complication after surgical interventions (especially on the nasal cavity and paranasal sinuses).
Pathomorphology. Subepidermal sagittal skin dissection. Minimal inflammatory reaction in tissues. Decrease in the number of lymphocytes in lymph nodes. Ulcerations of the mucous membrane of the vagina and cervix.

Clinical picture

Research methods

Special studies

Differential diagnosis

Treatment:

Lead tactics

Drug therapy

Treatment

Drug therapy

Precautionary measures

In severe renal failure, drug doses should be reduced.

Age characteristics. Children and teenagers. Sometimes observed as a complication of chickenpox.

See also ,

A41.9 Septicemia, unspecified

Streptococcal toxic shock syndrome, or toxic streptococcal syndrome, may be clinically indistinguishable from staphylococcal toxic shock.. 2012 .

Directory of diseases

See what "TOXIC SHOCK SYNDROME" is in other dictionaries: toxic shock syndrome - One of the most severe complications during vaccination, resulting from violations of the safety of immunization injections. [English-Russian glossary of basic terms in vaccinology and immunization. World Health Organization, 2009]… …

Technical Translator's Guide Streptococcal toxic shock syndrome, or toxic streptococcal syndrome, may be clinically indistinguishable from staphylococcal toxic shock.

Honey. Long-term crush syndrome is a shock-like state after prolonged compression of body parts by heavy objects, manifested by oligo or anuria due to impaired renal function by the breakdown products of crushed tissue (for example, ... ... Streptococcal Toxic Shock Syndrome - children's infection , the main symptoms of which are shock, fever and dysfunction of various organs. This disease is in many ways similar to toxic shock caused by staphylococci, but the cause of the disease...

Medical terms- (streptococcal toxic shock syndrome) is a childhood infectious disease, the main symptoms of which are shock, fever and dysfunction of various organs. This disease is in many ways similar to toxic shock caused by... ... Dictionary in medicine

LYELLA SYNDROME- (described by the Scottish dermatologist A. Lyell; synonyms - toxic epidermal necrolysis, scalded skin syndrome, necrotizing dermatitis, pemphigus-like dermatosis) - bullous lesions of the skin and mucous membranes with detachment of the epidermis and... ... encyclopedic Dictionary in psychology and pedagogy

Staphylococcal infection- (Greek staphylē bunch of grapes + kokkos grain) a group of various types clinical picture infectious diseases characterized by the presence of purulent inflammatory foci and intoxication. Etiology. The causative agent of S. and. are bacteria of the genus... ... Medical encyclopedia

Honey. The main advantage is the prevention of not only conception, but also infection with sexually transmitted diseases (including HSV, human papillomavirus, chlamydia, which contribute to the development of oncological diseases). The following are distinguished... Streptococcal toxic shock syndrome, or toxic streptococcal syndrome, may be clinically indistinguishable from staphylococcal toxic shock. - Active substance›› Hydroxyethyl starch Latin name Refortan GAK 6% ATX: ›› B05AA07 Hydroxyethyl starch Pharmacological group: Plasma and other blood components substitutes Nosological classification(ICD 10)… … Dictionary medical supplies

Toxic shock syndrome- an acute and severe multisystem disease characterized by sudden onset high fever, hypotension, vomiting, diarrhea, erythematous skin rashes that peel off during recovery, and damage to multiple organs.

Toxic shock syndrome is rare and often a life-threatening illness that develops suddenly after infection and can immediately affect multiple organ systems, including the lungs, kidneys, and liver.

Because toxic shock syndrome progresses rapidly, immediate medical treatment is necessary.

What triggers / Causes of Toxic Shock Syndrome:

Toxic shock syndrome is rarely the result of bacterial infection Streptococcus pyogenes(group A streptococcus) or Staphylococcus aureus(staphylococcus). These bacteria produce toxins causing the syndrome toxic shock. These bacteria are common but usually do not cause problems. They can cause easily treatable throat or skin infections, such as a sore throat or impetigo. In rare cases, toxins enter the bloodstream and cause a strong immune response in people whose bodies do not fight the toxins. The body's response causes symptoms associated with toxic shock syndrome.

Often appears after childbirth, flu, chicken pox, surgery, small cuts to the skin, wounds or bruises that cause bruising, but do not violate the integrity of the skin.

Often appears after prolonged use of tampons ( menstrual syndrome toxic shock) or after a surgical procedure such as nasal surgery using a dressing (nonmenstrual toxic shock syndrome).

Pathogenesis (what happens?) during Toxic Shock Syndrome:

The immune reaction leading to toxic shock syndrome is usually due to a lack of specific antibodies against streptococcal or staphylococcal toxins. Young people may not have such antibodies.

Outbreaks of toxic shock syndrome disease can occur in hospitals and long-term care facilities where people live in close proximity to each other.

Symptoms of Toxic Shock Syndrome:

The rapid development of symptoms is one of the most important symptoms that may require immediate treatment for toxic shock syndrome.

Symptoms of toxic shock vary in severity depending on the type of streptococcal or staphylococcal bacteria.

Symptoms of toxic shock syndrome develop quickly and can cause death within 2 days.

The first signs of toxic shock syndrome usually include:
- Such severe symptoms flu-like muscle aches and pain, stomach cramps, headache or sore throat.
- Sudden rise in temperature above 38.9 C.
- Vomiting and diarrhea.
- Signs of shock, including low blood pressure and rapid heart rate, often with dizziness, loss of consciousness, nausea, vomiting, or dysphoria and confusion.
- Redness similar to sunburn. Redness may appear in several parts of the body or in specific areas, such as the armpits or groin.
- Strong pain at the site of infection (if there is a wound or damage to the skin).
- Redness of the nasal passages and mouth.

Other symptoms of toxic shock syndrome may include:
- Conjunctivitis (redness).
- Involvement of more than one organ system, usually the lungs or kidneys.
- Blood poisoning (sepsis), which affects the entire body.
- Death of skin tissue (necrosis), which appears at the beginning of the syndrome.
- Peeling of skin tissue that appears during recovery.

Streptococcal nonmenstrual toxic shock syndrome.
Symptoms usually develop:
- In women who have recently given birth, 2-3 days or several weeks after birth.
- In people with infected surgical wounds, 2 days - 1 week after surgery.
- In people with respiratory diseases 2-6 weeks after the onset of respiratory symptoms.

Staphylococcal menstrual toxic shock syndrome. Symptoms usually develop 3-5 days after the start of menstruation when a woman uses tampons.

Staphylococcal nonmenstrual toxic shock syndrome. Symptoms usually develop within 12 hours of surgery that uses surgical dressings, such as rhinoplasty.

Symptoms of toxic shock syndrome can suddenly affect several different organ systems, including the lungs, kidneys, and liver.

Redness similar to a sunburn may also appear early in the disease. Redness usually appears after 7-14 days on the palms of the hands and soles of the feet.

Toxic shock syndrome occurs less frequently in children compared to adults.

Dangerous complications of toxic shock syndrome include:
- Shock, causing a reduction in blood circulation and oxygen in vital organs.
- Acute respiratory failure syndrome. Lung function decreases, it becomes difficult to breathe, and oxygen levels in the blood drop.
- Disseminated intravascular coagulation syndrome. This disease is caused by a blood clotting factor. Many blood clots can form throughout the body. This may cause excessive bleeding.
- Kidney failure, also called terminal stage renal failure. - Kidney failure occurs when kidney damage is so severe that treatment with dialysis or a kidney transplant is necessary to prevent death.

Talk to your doctor about possible complications if you have had multiple menstrual toxic shock syndromes.

Diagnosis of Toxic Shock Syndrome:

Because toxic shock syndrome progresses rapidly, it is usually diagnosed and treated based on symptoms and signs of infection without waiting for results laboratory tests. Additional blood and tissue testing can help determine the type of bacteria causing the infection.

Typically, by the time a person with toxic shock syndrome sees a doctor, the disease progresses rapidly and the person feels very unwell. Shock usually needs to be treated before any test results are available.

If your healthcare provider suspects you have toxic shock syndrome, you will undergo several types of tests, including:
- Full clinical analysis blood- counting red and white blood cells, platelets and other basic indicators of your blood.
- Cultures of blood and other fluids and tissues body for signs of streptococcal or staphylococcal bacteria. For menstrual toxic shock syndrome, a sample of vaginal fluid is tested. For nonmenstrual toxic shock syndrome, a swab or tissue sample is taken from a suspected lesion or other injured area of ​​the body. Blood culture usually does not detect staphylococcal toxic shock syndrome when it is present, but streptococcus can be detected in a blood or cerebrospinal fluid sample or by tissue biopsy. Cultures from the throat, vagina, or saliva may also reveal bacteria.
- Fluorography to look for signs of lung damage (respiratory distress syndrome).
- Tests to detect other infections which may cause symptoms similar to those of toxic shock syndrome, such as blood poisoning (sepsis), a tick-borne bacterial infection (American tick-borne rickettsiosis), a bacterial infection caused by contact with the urine of an infected animal (leptospirosis), or typhoid fever.

Sometimes other tests are needed, depending on how the disease has progressed and what problems it has caused.

Treatment of Toxic Shock Syndrome:

Emergency treatment often requires intravenous plasma volume resuscitation and intensive care in the hospital, especially when the body is in shock. Further treatment includes antibiotics to kill bacteria, removal of any source of infection, and treatment of any complications. Unless there are other complications, most people recover within 2 weeks when treated with antibiotics.

If you think you have toxic shock syndrome, call your doctor right away. If you have symptoms of shock such as severe weakness, dizziness or loss of consciousness, call an ambulance immediately. Because toxic shock syndrome can cause life-threatening complications, you may need to be treated in a hospital where your condition can be closely monitored.

By the time a person with toxic shock syndrome sees a doctor, it usually takes emergency treatment. Because toxic shock syndrome can progress very quickly and be life-threatening, treatment is almost always done in a hospital where the patient is closely monitored. Treatment for shock or organ failure is usually necessary before the results of any tests are known. Admission to intensive care is usually necessary when a patient shows signs of shock or trouble breathing (respiratory failure).

Treatment for streptococcal or staphylococcal toxic shock syndrome includes:
- Removing the source of infection. If a woman uses tampons, a diaphragm or a contraceptive sponge, they should be removed immediately. Infected wounds are usually cleared of bacteria. Your doctor may give you an injection to numb the area so that you can use a scalpel or scissors to remove dead or severely infected tissue. It is called surgical treatment wounds. Once the source of infection is removed, the patient's condition often improves quickly.
- Treatment of complications of the disease, including low blood pressure, shock and organ failure. The specifics of treatment depend on what problem arose. Introduction large quantity IV fluids are usually used to replace fluid losses due to vomiting, diarrhea and fever in order to avoid complications in the form low blood pressure and shock.
- Antibiotics to kill bacteria that produce toxins that cause toxic shock syndrome. Clindamycin stops the production of toxins and immediately treats symptoms. Other medications, such as cloxacillin or cefazolin, may be added when laboratory tests have detected specific streptococcal or staphylococcal bacteria. Staphylococcus aureus strains may be resistant to drugs such as cloxacillin and cefazolin, which are widely used around the world. These staphylococcal strains are called methicillin-resistant Staphylococcus aureus (MRSA). Other antibiotics may be needed to kill these bacteria. These antibiotics include vancomycin, daptomycin, linezolid, or tigecycline.

At timely treatment and lack serious complications most patients recover within 1-2 weeks.

Streptococcal toxic shock syndrome has a mortality rate of about 50%. This may be because streptococcal toxic shock syndrome can be difficult to identify until serious complications such as blood poisoning (sepsis) or a rare bacterial infection that destroys the skin (necrotizing fasciitis) occur.

Staphylococcal toxic shock syndrome is serious, but leads to death in only 5% of people who are not diagnosed and treated correctly.

Toxic shock syndrome is a rapidly progressive, life-threatening illness that cannot be treated at home. If you think you may have toxic shock syndrome, seek medical help immediately.

Antibiotics are used to treat toxic shock syndrome. The sooner therapy begins, the fewer possible complications may occur. Antibiotics are used for as long as needed, depending on the streptococcal or staphylococcal bacteria and the severity of the symptoms.

Antibiotics may also help prevent recurrent episodes of toxic shock syndrome.

Intravenous immunoglobulin administration may be used when toxic shock syndrome is severe or the patient's condition does not improve after taking antibiotics. IV immune globulin works differently than antibiotics. It contains antibodies that can help the body remove specific toxins that cause toxic shock syndrome. But experts have not determined whether intravenous administration immunoglobulin is effective in the treatment of toxic shock syndrome.

Your doctor can give you blood pressure medications to help your organs function better.

For toxic shock syndrome caused by staphylococcal bacteria, surgery is rarely required but is part of the necessary treatment. In some cases surgical removal infected tissue leads to a significant improvement in the patient's condition. For example, surgery may be necessary when:
- Toxic shock syndrome has developed after surgery and the surgical suture must be drained and cleaned to remove the source of infection.
- Streprococcal bacteria cause necrotizing fasciitis, a bacterial infection that destroys the skin, and the dead tissue and toxins produced by the bacteria must be removed.

Streptococcal toxic shock syndrome with necrotizing fasciitis progresses rapidly and is life-threatening, so it is necessary to emergency surgery to remove the source of infection.

In the hospital, you may need intravenous fluids and simple protein to replace what your body has lost.

Prevention of Toxic Shock Syndrome:

You can take next steps For prevent toxic shock syndrome:
- Do not use tampons or barrier contraceptives during the first 12 weeks after birth, when the risk of developing toxic shock syndrome is high.
- Follow the instructions on the package when inserting tampons, diaphragms or contraceptive sponges. Change tampons according to at least every 8 hours or use tampons only a few hours a day. Do not leave the diaphragm or contraceptive sponge in for more than 12-18 hours.
- Keep all skin wounds clean to prevent infection and promote healing. This includes cuts, punctures, scrapes, burns, insect or animal bites, and surgical stitches.
- Do not allow children to scratch chickenpox sores.
- If you have already had menstrual toxic shock syndrome, do not use tampons, barrier contraceptives such as a diaphragm, cervical cap, sponge, or intrauterine device(Navy).

Careful use of tampons, diaphragm and contraceptive sponge
- Follow package directions when inserting tampons, diaphragms, and contraceptive sponges.
- Wash your hands with soap and water before inserting or removing tampons, diaphragms, or contraceptive sponges.
- Change tampons at least every 8 hours or use tampons only a few hours a day. Do not leave the diaphragm and contraceptive sponge inside for more than 12-18 hours.
- As an alternative to tampons, use pads. For example, use pads at night and tampons during the day.
- Use tampons with a lower absorbency rate than you need. The risk of toxic shock syndrome is highest when using superabsorbent tampons.

Caring for skin wounds to prevent skin infections
- Keep all skin wounds clean to prevent infection and promote healing. Skin damage, including cuts, burns, bruises, insect and animal bites, chickenpox sores, and surgical stitches.
- Make sure children do not scratch chickenpox sores.

Preventing streptococcal infections during pregnancy or after childbirth

Women who are pregnant or have recently given birth have an increased risk of developing streptococcal toxic shock syndrome, especially if one of her children has strep throat. Any pregnant or postpartum woman with a baby who is showing signs of a sore throat should talk to her gynecologist or obstetrician.

Which doctors should you contact if you have Toxic Shock Syndrome:

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What is Toxic Shock Syndrome?

Toxic shock syndrome is rare and often a life-threatening illness that develops suddenly after infection and can immediately affect multiple organ systems, including the lungs, kidneys, and liver.

Because toxic shock syndrome progresses rapidly, immediate medical treatment is necessary.

What Causes Toxic Shock Syndrome?

Toxic shock syndrome is rarely the result of bacterial infection Streptococcus pyogenes(group A streptococcus) or Staphylococcus aureus(staphylococcus). These bacteria produce toxins that cause toxic shock syndrome. These bacteria are common but usually do not cause problems. They can cause easily treatable throat or skin infections, such as a sore throat or impetigo. In rare cases, toxins enter the bloodstream and cause a strong immune response in people whose bodies do not fight the toxins. The body's response causes symptoms associated with toxic shock syndrome.

Often appears after childbirth, flu, chicken pox, surgery, small cuts to the skin, wounds or bruises that cause bruising, but do not violate the integrity of the skin.

Often appears after prolonged use of tampons (menstrual toxic shock syndrome) or after a surgical procedure such as nasal surgery using a dressing (nonmenstrual toxic shock syndrome).

Pathogenesis (what happens?) during Toxic Shock Syndrome

The immune reaction leading to toxic shock syndrome is usually due to a lack of specific antibodies against streptococcal or staphylococcal toxins. Young people may not have such antibodies.

Outbreaks of toxic shock syndrome disease can occur in hospitals and long-term care facilities where people live in close proximity to each other.

Symptoms of Toxic Shock Syndrome

Rapid development of symptoms is one of the most important symptoms that may require immediate treatment for toxic shock syndrome.

Symptoms of toxic shock vary in severity depending on the type of streptococcal or staphylococcal bacteria.

Symptoms of toxic shock syndrome develop quickly and can cause death within 2 days.

The first signs of toxic shock syndrome usually include:
- Severe flu-like symptoms such as muscle aches and pain, stomach cramps, headache or sore throat.
- Sudden rise in temperature above 38.9 C.
- Vomiting and diarrhea.
- Signs of shock, including low blood pressure and rapid heart rate, often with dizziness, loss of consciousness, nausea, vomiting, or dysphoria and confusion.
- Redness similar to sunburn. Redness may appear in several parts of the body or in specific areas, such as the armpits or groin.
- Severe pain at the site of infection (if there is a wound or damage to the skin).
- Redness of the nasal passages and mouth.

Other symptoms of toxic shock syndrome may include:
- Conjunctivitis (redness).
- Involvement of more than one organ system, usually the lungs or kidneys.
- Blood poisoning (sepsis), which affects the entire body.
- Death of skin tissue (necrosis), which appears at the beginning of the syndrome.
- Peeling of skin tissue that appears during recovery.

Streptococcal nonmenstrual toxic shock syndrome.
Symptoms usually develop:
- In women who have recently given birth, 2-3 days or several weeks after birth.
- In people with infected surgical wounds, 2 days to 1 week after surgery.
- In people with respiratory diseases, 2-6 weeks after the onset of respiratory symptoms.

Staphylococcal menstrual toxic shock syndrome. Symptoms usually develop 3-5 days after the start of menstruation when a woman uses tampons.

Staphylococcal nonmenstrual toxic shock syndrome. Symptoms usually develop within 12 hours of surgery that uses surgical dressings, such as rhinoplasty.

Symptoms of toxic shock syndrome can suddenly affect several different organ systems, including the lungs, kidneys, and liver.

Redness similar to a sunburn may also appear early in the disease. Redness usually appears after 7-14 days on the palms of the hands and soles of the feet.

Toxic shock syndrome occurs less frequently in children compared to adults.

Dangerous complications of toxic shock syndrome include:
- Shock, causing a reduction in blood circulation and oxygen in vital organs.
- Acute respiratory failure syndrome. Lung function decreases, it becomes difficult to breathe, and oxygen levels in the blood drop.
- Disseminated intravascular coagulation syndrome. This disease is caused by a blood clotting factor. Many blood clots can form throughout the body. This may cause excessive bleeding.
- Kidney failure, also called end-stage renal disease. - Kidney failure occurs when kidney damage is so severe that treatment with dialysis or a kidney transplant is necessary to prevent death.

Talk to your doctor about possible complications if you have had multiple menstrual toxic shock syndromes.

Diagnosis of Toxic Shock Syndrome

Because toxic shock syndrome progresses rapidly, it is usually diagnosed and treated based on symptoms and signs of infection without waiting for laboratory test results. Additional blood and tissue testing can help determine the type of bacteria causing the infection.

Typically, by the time a person with toxic shock syndrome sees a doctor, the disease progresses rapidly and the person feels very unwell. Shock usually needs to be treated before any test results are available.

If your healthcare provider suspects you have toxic shock syndrome, you will undergo several types of tests, including:
- Complete clinical blood test- counting red and white blood cells, platelets and other basic indicators of your blood.
- Cultures of blood and other fluids and tissues body for signs of streptococcal or staphylococcal bacteria. For menstrual toxic shock syndrome, a sample of vaginal fluid is tested. For nonmenstrual toxic shock syndrome, a swab or tissue sample is taken from a suspected lesion or other injured area of ​​the body. Blood culture usually does not detect staphylococcal toxic shock syndrome when it is present, but streptococcus can be detected in a blood or cerebrospinal fluid sample or by tissue biopsy. Cultures from the throat, vagina, or saliva may also reveal bacteria.
- Fluorography to look for signs of lung damage (respiratory distress syndrome).
- Tests to detect other infections which can cause symptoms similar to those of toxic shock syndrome, such as blood poisoning (sepsis), a tick-borne bacterial infection (American tick-borne rickettsiosis), a bacterial infection caused by contact with the urine of an infected animal (leptospirosis), or typhoid fever.

Sometimes other tests are needed, depending on how the disease has progressed and what problems it has caused.

Treatment of Toxic Shock Syndrome

Emergency treatment often requires intravenous plasma volume resuscitation and intensive care in the hospital, especially when the body is in shock. Further treatment includes antibiotics to kill the bacteria, removal of any source of infection, and treatment of any complications. Unless there are other complications, most people recover within 2 weeks when treated with antibiotics.

If you think you have toxic shock syndrome, call your doctor right away. If you have symptoms of shock such as severe weakness, dizziness or loss of consciousness, call an ambulance immediately. Because toxic shock syndrome can cause life-threatening complications, you may need to be treated in a hospital where your condition can be closely monitored.

By the time a person with toxic shock syndrome sees a doctor, emergency treatment is usually required. Because toxic shock syndrome can progress very quickly and be life-threatening, treatment is almost always done in a hospital where the patient is closely monitored. Treatment for shock or organ failure is usually necessary before the results of any tests are known. Admission to intensive care is usually necessary when a patient shows signs of shock or trouble breathing (respiratory failure).

Treatment for streptococcal or staphylococcal toxic shock syndrome includes:
- Removing the source of infection. If a woman uses tampons, a diaphragm or a contraceptive sponge, they should be removed immediately. Infected wounds are usually cleared of bacteria. Your doctor may give you an injection to numb the area so that you can use a scalpel or scissors to remove dead or severely infected tissue. This is called debridement. Once the source of infection is removed, the patient's condition often improves quickly.
- Treatment of complications of the disease, including low blood pressure, shock and organ failure. The specifics of treatment depend on what problem arose. The administration of large amounts of intravenous fluid is usually used to replace fluid losses from vomiting, diarrhea and fever in order to avoid complications such as low blood pressure and shock.
- Antibiotics to kill bacteria that produce toxins that cause toxic shock syndrome. Clindamycin stops the production of toxins and immediately treats symptoms. Other medications, such as cloxacillin or cefazolin, may be added when laboratory tests have detected specific streptococcal or staphylococcal bacteria. Staphylococcus aureus strains may be resistant to drugs such as cloxacillin and cefazolin, which are widely used around the world. These staphylococcal strains are called methicillin-resistant Staphylococcus aureus (MRSA). Other antibiotics may be needed to kill these bacteria. These antibiotics include vancomycin, daptomycin, linezolid, or tigecycline.

With timely treatment and the absence of serious complications, most patients recover within 1-2 weeks.

Streptococcal toxic shock syndrome has a mortality rate of about 50%. This may be because streptococcal toxic shock syndrome can be difficult to identify until serious complications such as blood poisoning (sepsis) or a rare bacterial infection that destroys the skin (necrotizing fasciitis) occur.

Staphylococcal toxic shock syndrome is serious, but leads to death in only 5% of people who are not diagnosed and treated correctly.

Toxic shock syndrome is a rapidly progressive, life-threatening illness that cannot be treated at home. If you think you may have toxic shock syndrome, seek medical help immediately.

Antibiotics are used to treat toxic shock syndrome. The sooner therapy begins, the fewer possible complications may occur. Antibiotics are used for as long as needed, depending on the streptococcal or staphylococcal bacteria and the severity of the symptoms.

Antibiotics may also help prevent recurrent episodes of toxic shock syndrome.

Intravenous immunoglobulin administration may be used when toxic shock syndrome is severe or the patient's condition does not improve after taking antibiotics. IV immune globulin works differently than antibiotics. It contains antibodies that can help the body remove specific toxins that cause toxic shock syndrome. But experts have not determined whether intravenous immunoglobulin is effective in treating toxic shock syndrome.

Your doctor can give you blood pressure medications to help your organs function better.

For toxic shock syndrome caused by staph bacteria, surgery is rarely required but is part of the necessary treatment. In some cases, surgical removal of infected tissue leads to significant improvement in the patient's condition. For example, surgery may be necessary when:
- Toxic shock syndrome has developed after surgery and the surgical suture must be drained and cleaned to remove the source of infection.
- Streprococcal bacteria cause necrotizing fasciitis, a bacterial infection that destroys the skin, and the dead tissue and toxins produced by the bacteria must be removed.

Streptococcal toxic shock syndrome with necrotizing fasciitis progresses rapidly and is life-threatening, requiring emergency surgery to remove the source of infection.

In the hospital, you may need intravenous fluids and simple protein to replace what your body has lost.

Prevention of Toxic Shock Syndrome

You can take the following steps to prevent toxic shock syndrome:
- Do not use tampons or barrier contraceptives during the first 12 weeks after birth, when the risk of developing toxic shock syndrome is high.
- Follow the instructions on the package when inserting tampons, diaphragms or contraceptive sponges. Change your tampons at least every 8 hours, or only use tampons a few hours a day. Do not leave the diaphragm or contraceptive sponge in for more than 12-18 hours.
- Keep all skin wounds clean to prevent infection and promote healing. This includes cuts, punctures, scrapes, burns, insect or animal bites, and surgical stitches.
- Do not allow children to scratch chickenpox sores.
- If you have already had menstrual toxic shock syndrome, do not use tampons, barrier contraceptives such as a diaphragm, cervical cap, sponge, or intrauterine device (IUD).

Careful use of tampons, diaphragm and contraceptive sponge
- Follow package directions when inserting tampons, diaphragms, and contraceptive sponges.
- Wash your hands with soap and water before inserting or removing tampons, diaphragms, or contraceptive sponges.
- Change tampons at least every 8 hours or use tampons only a few hours a day. Do not leave the diaphragm and contraceptive sponge inside for more than 12-18 hours.
- As an alternative to tampons, use pads. For example, use pads at night and tampons during the day.
- Use tampons with a lower absorbency rate than you need. The risk of toxic shock syndrome is highest when using superabsorbent tampons.

Caring for skin wounds to prevent skin infections
- Keep all skin wounds clean to prevent infection and promote healing. Skin damage, including cuts, burns, bruises, insect and animal bites, chickenpox sores, and surgical stitches.
- Make sure children do not scratch chickenpox sores.

Preventing streptococcal infections during pregnancy or after childbirth

Women who are pregnant or have recently given birth have an increased risk of developing streptococcal toxic shock syndrome, especially if one of her children has strep throat. Any pregnant or postpartum woman with a baby who is showing signs of a sore throat should talk to her gynecologist or obstetrician.

Which doctors should you contact if you have Toxic Shock Syndrome?

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This serious disease from the multisystem group has an acute onset and requires immediate medical attention. It is rare, threatens not only health, but also life - it blocks the functions of the liver, respiratory, cardiovascular and urinary systems. The first signs of the disease are the appearance of high fever, drop in blood pressure, vomiting, diarrhea and multiple skin rashes.

Information about the disease

Toxic shock syndrome occurs when introduced into the body pathogenic flora various groups– group A streptococcus or staphylococcus. During their life, they constantly produce toxins. If immune reaction the introduction of negative microorganisms is expressed excessively intensely, then symptoms of toxic shock syndrome appear. Signs of shock during the introduction of microflora different types differ from each other.

Contact of the body with streptococci and the immune reaction manifests itself in the form of complications after suffering from influenza or chickenpox, after difficult childbirth and operations, but the introduction can be provoked by small microtraumas - bruises - which do not even cause a violation of the integrity of the skin surface.

Staphylococcal syndrome is caused by contact with dressings applied to open wounds. Staphylococcal toxic shock syndrome is classified as menstrual and non-menstrual - in the first case it is caused by surgical dressings, in the second by the use of intravaginal tampons.

Signs of the disease can be divided into primary and secondary.

Primary, most acute:

• muscle spasms;
• acute stomach pain and headache attacks;
• temperature rise above febrile values;
• vomiting and diarrhea;
• dizziness.

There may be disturbances of consciousness, rapid or slow heartbeat.

In certain parts of the body the skin turns red and the mucous membranes swell oral cavity. If the shock is caused by an injury, severe pain is felt at the site of the injury.

Secondary symptoms of toxic shock:

• sepsis;
• conjunctivitis;
• tissue necrosis localized in certain areas;
• dysfunctions of the urinary and respiratory systems.

In streptococcal nonmenstrual toxic shock syndrome, signs may appear after the introduction of pathogenic microorganisms within 2-5 days, but incubation period can sometimes reach 10-12 days.

This picture is possible after a difficult birth or surgery, which - at first glance - proceeded without complications.

Symptoms of toxic shock syndrome from tampons appear 3-5 days after the start of menstruation and increase sharply.

The same signs of nonmenstrual shock occur after surgery no later than 12 hours later.

Diagnosis and treatment of the disease

Drug therapy for toxic shock syndrome begins before laboratory test results are obtained - the diagnosis is made based on symptoms. If you wait for confirmation of the disease, the patient may no longer be saved.

However, tests are still taken to accurately identify the pathogen and to clarify the prescription of medications - therapy must be precisely aimed at the targeted destruction of pathogenic flora that has entered the body.

The following types of tests are required:

• expanded general analysis blood;
• tank. blood and urine culture to identify the type of pathogenic flora;
• radiography for respiratory failure syndrome;
• blood tests from a vein to identify concomitant infections.

If it is suspected that toxic shock syndrome is caused by the use of tampons, a vaginal smear must be taken; in the case of non-menstrual syndrome, a sample of fluid or part of tissue from the infected surface.

Since the onset of the disease is quite acute and poses a threat to the patient’s life, intensive care measures are immediately taken after hospitalization - the volume of plasma in the body is restored using a dropper. Without hospitalization, it is impossible to save the patient; if respiratory failure develops, intubation of the lungs may be required.

Treatment for toxic shock syndrome is carried out according to the following scheme:

1. The source of infection is removed. All bandages are removed, tampons are removed;
2. The surface of the wound or skin at the site of possible infection is cleaned. More often this procedure is performed under local anesthesia - dead or infected inflamed tissue may need to be removed promptly;

Usually, after the source of infection is eliminated, the patient's condition begins to improve.

1. Treatment of complications caused by toxic shock begins - therapeutic measures depend on their manifestations;
2. Antibiotics are required - each type of pathogenic flora requires its own group antibacterial drugs. Antibiotic therapy is specified after the strain is isolated in the laboratory;
3. To normalize blood pressure, medications are necessarily used - for low blood pressure organic systems cannot function to the required extent;
4. If the patient's condition does not improve after the administration of antibiotics, immunoglobulin may be required. It stimulates the body's production of antibodies, which help heal itself.

From medical workers an immediate response is required - streptococcal toxic shock syndrome leads to death in 50% of cases. Its complications are extremely serious: sepsis or necrotizing fasciitis, a disease that destroys the skin.

In this case, it is necessary to resort to surgical intervention to completely remove the embedding area.

Staphylococcal syndrome is less dangerous death is recorded in only 5% of infections.

Even if the patient’s condition has returned to normal, the therapeutic course of antibiotics must be completed in full - toxic shock syndrome can recur. When serious complications are stopped and treated correctly, patients recover within 10-12 days after the start of intensive therapy.

Prevention of toxic shock syndrome

To prevent a dangerous condition from occurring, certain measures must be taken.

All wounds and injuries to the skin surface must be treated antiseptics, make sure that the injuries are not scratched. The risk of infection can be completely eliminated by applying sterile dressings if the wound is bleeding.

Skin wounds include:

• scratches;
• microtraumas;
• hematomas from bruises;
• postoperative sutures at the healing stage;
• insect and animal bites;
• papules from chickenpox, scarlet fever and measles.

Women have an increased risk of developing toxic shock syndrome. postpartum period if her family has a sore throat or is experiencing an exacerbation chronic tonsillitis. In this case, she needs quarantine conditions.

After childbirth for containment bloody discharge– lochia – only sanitary pads are used. You can switch to more “reliable” methods of protection - tampons - when menstruation appears only when 4-6 months have passed after the birth of the child.

Update: October 2018

IN last years Sanitary tampons have become widespread among women. This fact is not surprising, because tampons allow you to go to the pool and the beach, wear tight-fitting and light-colored clothes during menstruation, dance and generally lead a normal lifestyle. However, many manufacturers of this hygiene product are silent about such a serious fact as the development of toxic shock syndrome from tampons. This pathology, although rare, progresses very quickly, is difficult to treat, and in 5% (according to some data in 8–16%) ends in death.

Historical reference

The history of the existence of hygienic tampons goes back several thousand years. The first hygiene products, only vaguely reminiscent of tampons, appeared in Ancient Egypt, which Egyptian women made from flax fibers. IN Ancient Rome women rolled soft wool into rolls and greased them for easy insertion and removal. Representatives of the fairer sex of Syria and Babylon rolled papyrus (for rich ladies) or reeds (for poor women). In Japan, to make life easier in critical days Rice paper was used, rolled into balls the size of a walnut. Eskimos used moss or very thin alder wood shavings to produce so-called tampons, and some used fur as the basis for tampons.

The second birth of hygienic tampons is considered to be the thirties of the last century. Invented and patented this remedy hygiene doctor USA Erlem Haas. The tampons created by Haas were made from compressed cotton wool, which was wrapped in gauze. A US citizen, German Gertrude Tenderich, turned out to be more enterprising, who bought the patent from the founder of tampons and opened the Tampax company. Those first tampons did not shine with special convenience and comfort.

But the improvement of these hygiene products was constant. Later, tampons had a thread, pulling on which made the process of removing it easier. Later they were joined by applicators, with the help of which the insertion of tampons became more convenient. But one mistake by tampon manufacturers almost brought down the entire hygiene campaign to improve life during menstruation.

In an effort to maximize the absorption (absorbing) properties of tampons, Procter & Gamble decided to replace the cotton and viscose that make up tampons with a synthetic material that absorbs liquid well and is impregnated with a hyperabsorbent. This hyperabsorbent was a food thickener and was called cellulose gum.

It was this component of hygiene products that laid the foundation for toxic shock syndrome from tampons. The absorbent caused vaginal dryness, as a result of which its mucous membrane was easily injured when removing the tampon, allowing bacteria access to the blood vessels. In addition, cellulose gum disrupted the normal vaginal microflora, thereby allowing pathogenic bacteria to multiply.

In the 80th year of the 20th century, doctors noted a strange trend - the incidence of this syndrome has increased greatly among women, although the pathology is usually observed in burn patients. 800 women were affected, and 38 of them died. After analyzing the incidence, it became clear that the trigger point for the emergence of toxic shock syndrome was the use of hygienic tampons. All products were withdrawn from sale and the percentage of cases fell sharply.

Between 1976 and 1996, 5,296 women were diagnosed with TSS. Today, TSS affects one in 100 thousand people. However, it does not follow from the above that TSS affects only women, and reproductive age who use sanitary tampons. The percentage of TSS cases in men is 15 of the total number of reported cases. In addition, even refusing to use these hygiene products will not prevent the development of TSS if the immune system is weakened.

What are the dangers of modern tampons?

Modern hygienic tampons are not only convenient and comfortable to use and make life easier during menstruation. The components from which tampons are made can have a negative impact on women's health if used continuously:

• Dioxin

Dioxin is used as a bleach to make the tampon white. It is considered a potential carcinogen, meaning it can cause cancer. Due to the toxic reactions that this component causes in the reproductive and immune system significant disruptions occur. Dioxin reduces the number of sperm in the ejaculate and provokes the occurrence of endometriosis in the body of women. This chemical component decomposes extremely slowly, which leads to its accumulation in the body. Therefore, the risk of the negative effects of dioxin increases significantly with regular use of tampons, although manufacturers believe that the content of this component in tampons is very low and does not affect health.

• Viscose

Excellent absorbent - absorbs blood well. Viscose is made from wood and treated with dioxin. When the tampon is removed, viscose fibers remain on the vaginal mucosa. Thus, a tiny dose of dioxin continues to affect the body.

• Cotton

Experts say that genetically modified cotton is used to produce tampons, which increases the resistance (resistance) of bacteria to antibiotics. Women who use tampons cannot recover from inflammatory processes in the genital organs longer. Also, after removing the tampon from the vagina, cotton fibers remain on its mucosa, which are only partially removed with vaginal discharge. The remaining fibers provoke the appearance of microtraumas and ulcers, which facilitates infection by pathogenic bacteria, in particular, latent sexually transmitted infections.

Besides, Negative influence sanitary tampons consists of:

• obstruction of the outflow of menstrual blood containing staphylococcal endotoxins, which can result in backflow of blood into the uterine cavity, from there into the tubes, and then into abdominal cavity;
• change internal environment vagina (anaerobic becomes aerobic, in which Staphylococcus aureus feels great and begins to actively multiply);
• absorption of magnesium ions, which suppress the production of toxins by Staphylococcus aureus;
• absorption of the nutrient substrate of lactic acid bacteria, which reduces their number and leads to the activation of opportunistic vaginal microflora.

Definition of toxic shock syndrome

Tampon toxic shock syndrome, or TSS (also known as menstrual toxic shock syndrome), is a rare and serious condition caused by bacterial infection. This pathology develops acutely and affects almost all organs and systems of the body (lungs, liver and kidneys, blood vessels and skin. Exposure to toxins produced by Staphylococcus aureus leads to the occurrence of TSS. Despite the similarity of the symptoms of this pathology with those of the flu, TSS is characterized by a sudden and a rapid onset (a sharp deterioration in the condition occurs within several hours) and a high probability of death.

Researchers at the National Institutes of Health believe that using sanitary tampons increases the chances of developing the disease by up to 50%.

Epidemiology

TSS is characterized by:

• the occurrence in women of a certain age group(from 17 to 30 years), which is due to insufficiently developed immunity;
• development in 55% during menstrual flow;
• using tampons during menstruation in 99% of TSS cases;
• TSS, which is not associated with vaginal infection, is diagnosed equally often in both men and women, and can occur in both newborns and the elderly;
• TSS can occur in any situation when the immune system is weakened, which contributes to the proliferation of Staphylococcus aureus and its production of toxin (influenza, ARVI, wound infection);
• recurrence of toxic shock syndrome occurs in 30 - 60% of cases, especially if antistaphylococcal therapy was not carried out.

Causes and mechanism of development

TSS from tampons is caused by opportunistic bacteria - Staphylococcus aureus, which is found in every fifth to tenth woman. normal microflora vagina. For the time being, Staphylococcus aureus behaves quite peacefully. But as soon as the immune system weakens and microcracks appear on the vaginal mucosa, the bacterium becomes pathogenic, and very aggressive. It is not so much the bacteria themselves that play a role in the development of TSS, but the endotoxins they produce. Massive production of toxins disrupts the functioning of almost all organs and systems, which leads to the development of TSS.

Pathogenesis of TSS

IN circulatory system A huge amount of toxins penetrates through small vessels. The influx of toxins provokes a sharp release of adrenaline and other biological factors into the bloodstream. active substances. Due to the action of adrenaline, post-capillary venules and arterioles spasm, and additional arteriovenous shunts open. But the blood entering the shunts is not able to provide oxygen internal organs fully, which leads to the development of ischemia in them and metabolic acidosis(decrease in blood pH). As a result, blood circulation is impaired and hypoxia occurs in the tissues.

Damage to body systems is caused by the deposition of blood in capillaries, and its liquid part enters the intercellular space. Accordingly, hypovolemia develops (a sharply reduced volume of circulating blood, which causes a drop in blood pressure). Kidney perfusion (blood supply) also decreases, which inhibits glomerular filtration (formation of primary urine). Kidney swelling occurs, and then acute renal failure. Similar processes are observed in the lungs with the development of respiratory failure and pulmonary edema.

Features of Staphylococcus aureus

This type of microorganisms is characterized by:

• high pathogenicity;
• resistance to adverse environmental conditions;
• the ability to penetrate any organs;
• presence (in small quantities) on skin and mucous membranes.

However, not all women develop TSS, even with regular use of tampons, why? The fact is that many adults (about 80%) are immune to Staphylococcus aureus toxin. Antibodies to endotoxins are developed throughout life (transferred skin infections, surgical interventions And so on). How stronger immunity, the less chance Staphylococcus aureus has of making a hole in it. That's why this pathology common among young women (under 30 years of age) who have not yet developed a sufficient amount of antibodies to the toxins of Staphylococcus aureus.

Risk factors

Menstrual toxic shock syndrome can be triggered by:

• constant use of sanitary tampons;
• use of vaginal contraceptives (spermicidal sponges, caps or diaphragms);
• recent birth;
• presence of chronic inflammatory diseases reproductive system;
• bacterial vaginosis, urogenital candidiasis, hidden sexually transmitted infections;
• weakened immune system;
• neglect of the rules of hygiene and insertion/removal of tampons;
• intracavitary operations.

Clinical picture

Menstrual TSS develops suddenly, in the setting of complete health, and progresses very quickly. If left untreated, death can occur within two days. Symptoms of toxic shock syndrome include:

• a significant increase in temperature (up to 39 degrees or above);
• low blood pressure ( main feature all types of shock), the impossibility is in vertical position– orthostatic syncope (fainting);
• nausea and vomiting, clouding of consciousness, increased heart rate and dizziness are a consequence of low blood pressure (systolic less than 90 mm Hg);
• muscle pain and spasms, convulsions (tissue hypoxia);
• gastrointestinal disorder (vomiting, profuse diarrhea - watery stools) - the effect of endotoxins;
• the appearance of a rash - multiple hyperemic spots up to 1 cm in diameter on the skin, reminiscent of a sunburn;
• desquamation (flaking) of the skin occurs 7–14 days after the onset of TSS;
• damage to the mucous membranes (redness of the vagina and oropharynx, the occurrence of non-purulent conjunctivitis, “crimson tongue”);
• an increase in leukocytes in the urine in the absence of infection;
• liver damage (increased bilirubin, AST and ALT);
• impaired hematopoiesis (sharp decrease in platelets);
• damage to the central nervous system (impaired consciousness - stupor, stupor, disorientation, hallucinations even against the background normal temperature and pressure);
• damage to the cardiopulmonary system (pulmonary edema, syndrome respiratory disorders, heart block);
• development of sepsis;
• seeding Staphylococcus aureus from the cerebrospinal fluid and from the pharyngeal mucosa.

Diagnostics

The presence of TSS can be suspected by characteristic Clinical signs and the appearance of the patient (sluggish, lethargic, with severe pallor and cyanosis). If the patient has an unexplained fever, multiple lesions of body systems against the background of skin flushing and rash, and associated with menstruation, the doctor must first exclude/confirm TSS.

Clinical tests:

• General (detailed) blood test

Determination of erythrocytes and hemoglobin (reduced), leukocytes (increased, shift of the formula to the left, possible lymphocytopenia), platelets (reduced), clotting time and bleeding time 9 coagulopathy).

• Blood chemistry

Decline total protein and albumin, electrolyte imbalance, decreased calcium, phosphorus and magnesium, increased nitrogen and creatinine, AST and ALT, increased bilirubin and calcitonin.

• General urine analysis

Azotemia, significant leukocyturia (sterile pyuria), detection of leached red blood cells.

• Tank. biological fluid cultures

For cultures, smears are taken from the vagina and rectum, from the cervix, conjunctiva, oropharynx and nose. They also “sow” blood, urine and cerebrospinal fluid.

• Tests for other, similar infections

Tick-borne rickettsiosis and leptospirosis, sepsis and typhoid fever, streptococcal infection(scarlet fever) and meningococcal infection.

• Determination of antibodies to Staphylococcus aureus

There are no antibodies.

In addition, fluorography is mandatory (determining the degree of lung damage and respiratory failure.

Treatment

Treatment for toxic shock syndrome is long and complex. All patients are necessarily hospitalized, and in the intensive care unit, where intensive therapy is carried out, aimed at restoring the functioning of damaged organs and systems.

First aid

If a woman suspects she has TSS, loved ones should immediately call ambulance and take a number of measures:

• remove the sanitary tampon or local contraceptives (caps, diaphragms) if possible;
• unbutton clothes to make breathing easier;
• put the patient to bed, apply a heating pad to her feet;
• open the window for fresh air.

Intensive therapy

• Bed rest, dynamic monitoring of the patient

Measuring blood pressure and temperature, counting pulse and respiration rate.

• Restoring intravascular volume

To eliminate hypovolemia, intravenous infusions are prescribed saline solutions(physiological, Ringer's solution and glucose) and fresh frozen plasma in a volume of 4 - 5 liters per day (in some cases, the amount of fluid administered is increased to 8 - 12 liters).

• Raising and maintaining blood pressure

Dopamine is injected intravenously (continuously) starting at a dosage of 2–5 mcg/kg per minute, then the dose is gradually increased until normal numbers are reached. Dopamine increases myocardial contraction and heart rate, dilates renal, mesenteric (intestinal) and cerebral vessels, and skeletal muscles narrows, which leads to normalization of blood circulation in vital organs.

• Administration of glucocorticoids

Glucocorticoids have antishock (blood pressure support), anti-inflammatory, antiallergic, antitoxic and immunosuppressive effects. As a rule, dexamethasone or prednisolone is prescribed (orally, intramuscularly or intravenously, depending on the patient's condition).

• Administration of antibiotics

The selection of antibiotics is carried out taking into account their resistance to beta-lactamase and activity against staphylococci. Prescribing antibiotics does not reduce the duration of the acute phase of toxic shock and does not relieve clinical signs, but significantly reduces the frequency of relapses of TSS. Preference is given to penicillins (amoxiclav, oxacillin, methicillin, nafcillin) and cephalosporins. In case of allergy to penicillins, vancomycin, clindamycin, dapotmycin or linezolin are prescribed. Antibiotics are administered intravenously, then intramuscularly.

• Prevention of respiratory disorders

This is carried out using oxygen, which is supplied through a mask or nasal cannula. At the same time, gas monitoring is carried out in arterial blood. In cases of respiratory failure, the patient is transferred to artificial ventilation lungs.

• Normalization of hemocoagulation

If the coagulogram deviates from normal values ​​or there are signs of bleeding, colloidal solutions (infucol, reopolyglucin), fresh frozen plasma, cryoprecipitate are administered intravenously, or donor blood is transfused. At sharp decline platelets, platelet mass is administered.

• Antistaphylococcal immunoglobulin

The drug is administered intravenously when the patient is in serious condition. Immunoglobulin contains antibodies that neutralize Staphylococcus aureus toxins.

With timely and adequate treatment, normalization of body temperature and blood pressure occurs within two days after the start of treatment. Laboratory indicators normalizes by the end of the 1st - 2nd week, and the restoration of hemoglobin and red blood cells after 4 - 6 weeks.

Complications of TSS

Possible complications of the disease:

• relapse of TSS usually occurs within the second month after treatment in patients who were not prescribed beta-lactamase-resistant antibiotics (60%)
• renal and liver failure;
• death (in 5%);
• heart failure;
• decreased mental abilities (concentration, intelligence, memory impairment);
• sepsis.

Question answer

Question:
I had TSS from tampons about two months ago. She was discharged from the hospital with recovery. But now I noticed that my hair began to fall out a lot and my nails were peeling. What to do?

Splitting nails and hair loss are consequences past illness. Do not panic, these phenomena are reversible. Take multivitamins, stimulate nonspecific immunity, spend cosmetic procedures for hair and nail care (nail baths, rinsing hair with decoctions of medicinal herbs, medicinal masks).

Question:
I prefer to use sanitary tampons, but I learned about possible complication when using them - TSS. What should I do to prevent this disease from occurring?

First, you must wash your hands thoroughly when inserting and removing a tampon. Secondly, do not allow the tampon to remain in the vagina for a long time (more than 4 hours) and remove it, even if it is not yet completely saturated. Thirdly, use tampons with a low degree of absorption (requires frequent replacement and is less damaging to the vaginal mucosa). Also, at night and on days of minor bleeding, replace tampons with pads. It is not recommended to use tampons with aromatic additives, especially for women prone to allergies. It is prohibited to insert tampons during acute or exacerbation of inflammatory process in the female genital organs and after TSS.

Question:
Why can't you get TSS from using pads? What is the difference between pads and tampons for TSS?

Because the tampon is located inside the body, where it collects blood - optimal nutrient medium For Staphylococcus aureus. Toxins released by bacteria immediately penetrate into the bloodstream through microcracks that appear during the insertion and removal of tampons. In addition, “old” blood, together with pathogenic microbes from the tampon, can enter the uterus, and from there into the abdominal cavity (for example, I forgot about the tampon at the end of menstruation when I inserted it to absorb residual minor discharge, but forgot to delete). Pads do not cause microtrauma to the external genitalia, do not cause blood stagnation in the vagina and are changed in a timely manner (the woman sees that the pad is no longer suitable for use).