Retro infection: Toxic shock makes a return

In the late 1970s, before AIDS erupted into a pandemic, genital herpes was the fear-provoking disease. Also briefly notorious at that time: toxic shock syndrome. In 1980, 38 women died and the 812 reported cases were blamed on tampons– in particular, the highly absorbent Rely brand.

Staunton resident Jean Carter, 39, remembers all too well because it was the brand she and her mother used, and her mom went out and bought up a supply before Proctor and Gamble took Rely off the market.

At the height of the scare, women were advised to use lower-absorbency tampons and change them more frequently, and toxic shock syndrome faded into the history books.

That is, until this past Christmas, when Carter's 18-year-old daughter, Melissa, nearly died from toxic shock syndrome.

Her dad thought something was weird when Melissa left her job at Country Cookin' early Christmas Eve. "For her to come home sick is unusual," says Charles Carter.

She began throwing up, and her symptoms– fever, diarrhea, headache, muscle aches– seemed typical of a 24-hour flu. After she lost consciousness on Christmas Day, her family took her to the Augusta Medical Center.

By then Melissa was severely dehydrated, her blood pressure had dropped, and her kidneys had ceased functioning, according to her father. Her parents were told she might have a severe intestinal bacteria, or a rare kidney disease– or perhaps spinal meningitis.

"What if she has toxic shock?" Jean Carter wondered, when doctors initially were flummoxed by her daughter's condition?

"I read the inserts, and it was at the end of her cycle," explains Carter. "It fit with the symptoms in the pamphlet. And I'm a mother of three girls."

The Augusta hospital transported Melissa to the UVA Medical Center December 26. Even at UVA, says Charles Carter, an intern wanted to pursue the meningitis theory and give Melissa a spinal tap. Carter refused to give permission for the procedure until toxic shock syndrome was ruled out.

Within five minutes of giving her a pelvic exam, "They said with the rashes coming up, what we see is no doubt toxic shock," says Carter.

Infectious diseases expert Dr. Costi Sifri says his residents called him after Melissa was admitted, concerned about symptoms that suggested toxic shock syndrome.

"It's a rare infection," he says, and since the Rely tampon was taken off the market 25 years ago, "Young women may not know about it."

Sifri explains there are two kind of toxic shock: staphylococcus, which he says is associated with tampon use, and streptococcal, which claims a higher mortality rate.

Melissa's toxic shock was caused by the staphylococcus bacteria, which is present in nine percent of women. "It's a very common bacteria– but a pretty rare infection," says Sifri. "You'd assume those women are menstruating, so why do only some get it?"

Even today, the causes of toxic shock are still not fully understood. "It sort of has to be the perfect storm– the right bacteria, the right type of infection during menstruation, or the right type of wound," says Sifri.

While some medical professionals urge storing tampons and barrier contraceptives away from the bacteria-fostering heat and moisture found in bathrooms, Dr. Sifri does not believe the location was a factor in Melissa's infection.

Melissa was in the hospital for seven days including Christmas, and the Robert E. Lee High School senior missed her 18th birthday on December 28.

"People are saying it's a miraculous recovery," she says from home January 2.

She'll have peeling on her hands and feet from the rash, but she experienced no permanent kidney damage. Melissa, who has been accepted at Mary Baldwin College and hopes to study nursing, was eager to get back to school.

"Tampons are not the enemy," she says– although she advises not keeping them in the bathroom.

Her parents are determined that people know toxic shock syndrome is not a bygone infection of the late '70s. "The danger is it's so much like an intestinal flu," says Charles Carter. "The kidneys start to shut down before you know it."

Charles and Jean Carter remember when toxic shock syndrome was in the news in 1980, but little dreamed it would infect their daughter, Melissa, right, and that they'd spend three days unsure of her survival.