Toxic shock syndrome is extremely rare — in 2016 there were just 40 reported cases in the United States, and about half were not related to menstruating women, Dr. Mary Jane Minkin, an ob-gyn from Yale University and member of PEOPLE’s Health Squad, told PEOPLE.
But when TSS does occur, it develops from toxins already present in the body.
“The first is vaginal colonization with a strain of S. aureus, which can make the toxin; the second is production by the S. aureus of the toxin; the third is penetration across the vaginal epithelium of enough toxin to cause disease; and the fourth is a lack of adequate titers of the neutralizing antibody to the toxin,”
Dr. JoAnn Pinkerton, executive director of The North American Menopause Society told PEOPLE.
And women of younger ages are more susceptible to the disease.
“Younger women are more likely to get TSS, possibly because of more exposure through tampons or barrier contraceptive use,” Pinkerton said. “It may also be because they haven’t developed the antibodies yet.”
To reduce the chance of developing TSS, Pinkerton and Minkin recommend swapping out tampons every two to three hours, and avoid sleeping in them overnight. Additionally, it’s best to use lower-absorbency tampons to reduce dryness, and to switch off between tampons and pads.
However, Minkin said that women should not be overly concerned.
“The tampons themselves are not contaminated with bacteria,” she said.
“The nasty staph organisms are unfortunately carried by us, not the tampons. So I would encourage all women to pay attention to their health, but not to worry.”