Toxic Shock Syndrome (TSS)

What is toxic shock syndrome?

Toxic shock syndrome, or TSS, is a rare, life-threatening bacterial illness marked by high fever, lower blood pressure, rash and the shut-down of multiple organ systems. It became a household word only in the 1980s, after an epidemic of the disease was linked to tampon use.

What causes it?

The illness is caused by common staph bacteria that include Staphylococcus aureus. These bacteria live on the moist surfaces of our bodies (such as the tissues lining the nose or vagina) without causing harm. Researchers think toxic shock syndrome develops, however, when the bacteria invade the bloodstream through small cuts, abrasions, or an open wound and release toxins, or poisons.

Who can get it?

Medical journals have reported an illness resembling toxic shock syndrome ever since the 1920s, but it was identified only in 1978 among children and, in the 1980s, to a rash of cases linked to the use of high-absorbency tampons.

Publicity about toxic shock syndrome, government regulation, and clearer instructions from tampon manufacturers led to a sharp decline in the incidence of the disease; in 1998 there were only 3 confirmed cases among menstruating women, compared with 814 cases in 1980. But although the illness is rare, it’s still an important health concern. The Centers for Disease Control and Prevention has stopped tracking toxic shock syndrome, but there was a rise in cases in the early 2000s — an increase that some experts attributed to the continued use of high-absorbency tampons and manufacturers dropping the warning not to leave them in overnight.

Now, non-menstrual TSS accounts for about half of all cases. Initially, most TSS cases involved very young women in their late teens and early twenties. If a wound, burn, boil, or insect bite gets infected with the bacteria, someone who isn’t menstruating or isn’t female can also suffer toxic shock. In addition, about 30 percent of the women who have had the illness get it again.

Why is toxic shock syndrome so dangerous?

Some symptoms of toxic shock syndrome, like a high fever and a sore throat, are so similar to those of flu and other common ailments that it’s easy to dismiss it until the situation becomes serious. But toxic shock syndrome can progress very swiftly, and a victim may die of heart and lung failure within hours or days if it goes untreated.

How can I tell if I have toxic shock syndrome?

The most common symptoms are:

  • Chills and aching muscles
  • A high fever of 102 to 105 degrees
  • Headache
  • A sore throat
  • Low blood pressure
  • Vomiting
  • Diarrhea
  • Fainting
  • Seizures
  • A flat red rash that looks like a sunburn and may appear on the palms of hands and soles of the feet
  • Hallucinations or dizziness

In addition, the skin on the palms of the hands and on the soles of the feet may peel.

What causes toxic shock syndrome?

Research has suggested that highly absorbent tampons increase the risk of toxic shock syndrome because they may dry out and tear the lining of your vagina when they’re removed. Provided with this way in, the bacteria infect your body and produce toxins that are hard for it to fight off. Other experts believe that if tampons that are left in for a long time become a breeding ground for bacteria.

In rarer cases, women have gotten TSS while wearing a diaphragm or contraceptive sponge. But children, men and old people can also develop toxic shock syndrome. You can get it from a staph or strep infection, an infected skin wound, surgery (especially a nose job) and medical conditions such as influenza.

Can you get toxic shock from a diaphragm or a cervical cap?

In rare cases, women have developed toxic shock syndrome after leaving a diaphragm or a cervical cap in too long. You should keep a diaphragm in for no more than six hours after sex; don’t leave it in longer than 24 hours even if you have sex again.

Are there toxic materials in tampons?

Rumors have appeared on the Internet that tampons contain a number of dangerous materials (such as asbestos) that can cause toxic shock syndrome. The Food and Drug Administration, however, has stated that materials like asbestos have never been used in tampons. Some tampons do contain rayon, but according to the FDA, studies demonstrate that they’re no more likely to cause toxic shock syndrome than cotton tampons of similar absorbency.

How is toxic shock syndrome treated?

Once identified, fortunately, it’s usually easily treated with antibiotics and large amounts of intravenous fluid to raise the patient’s blood pressure. The problem is, a woman can easily come down with it again. Women who get the disease once should immediately stop using tampons to protect themselves against another infection.

How can I avoid toxic shock syndrome?

Doctors advise that you not use superabsorbent tampons when you’re menstruating. Read the instructions to decide what size is best for you. You should also try to do the following:

Use sanitary napkins rather than tampons if possible and change them regularly

If you want to use tampons, use brands with the lowest absorbency and alternate them with sanitary napkins and panty liners (the Food and Drug Administration now mandates that tampon boxes carry an absorbency “rating”)

Keep the bacteria from spreading by washing your hands before and after you insert a tampon

If a tampon is irritating or hard to remove, switch to a less absorbent variety

Change your tampon every four to six hours

Never leave a tampon in overnight

Never use more than one tampon at a time

Make sure even minor skin wounds are washed and covered, and change the dressing regularly. Go to the doctor if you develop sudden, unusual pain, redness, lumps or swelling at the site of the wound.

Wash your hands regularly, especially after you touch your nose.

What should I do if I think I have toxic shock syndrome?

If you’re using a tampon, take it out immediately to prevent some of the most dangerous symptoms of the disease. Then call 911 or get emergency help from a doctor at once. Be sure to tell him or her whether you’ve had toxic shock syndrome before.


Toxic Shock Syndrome, Mayo Clinic Online, 2009.

National Institutes of Health. Toxic Shock Syndrome. September 2006.

Centers for Disease Control. Toxic Shock Syndrome. October 2005.

Toxic Shock Syndrome: Broadening the Differential Diagnosis, Christopher M. Herzer, MD, J Am Board Fam Pract 14(2):131-136, 2000.

Food and Drug Administration. Menstrual Tampons and Pads, 2005

Tampons and Asbestos, Dioxin, and Toxic Shock Syndrome, U.S. Food and Drug Administration Center for Devices and Radiological Health, July 23, 1999

On the Teen Scene, TSS: Reducing the Risk, Dixie Farley, FDA Consumer, October 1991

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