[Tampon disease, still not past tense].

On the basis of three case histories we discuss the menstrual toxic shock syndrome (TSS), characterised by multi-organ involvement, fever, exanthema and shock. The symptoms are provoked by a toxin (TSST-1), a product of certain St. aureus strains. Rapid recognition is important in order to prevent complications such as the adult respiratory distress syndrome, disseminated intravascular coagulation or ventricular fibrillation. It appears that a tampon can lower the magnesium concentration in the vagina by a process of ion exchange, thus creating an environment that favours the production of TSST-1 by St. aureus. This knowledge may lead to preventive measures in the production of tampons in the future.