Toxic Shock Syndrome

Medically Reviewed by Nivin Todd, MD on September 12, 2022

Toxic shock syndrome is a sudden, potentially fatal condition. It's caused by the release of toxins from an overgrowth of bacteria called Staphylococcus aureus, or staph, which is found in many women's bodies. Toxic shock syndrome affects menstruating women, especially those who use super-absorbent tampons. The body responds to the infection with a sharp drop in blood pressure that deprives organs of oxygen and can lead to death.

This disease made headlines in the late 1970s and early 1980s after the deaths of several young women who were using a brand of super-absorbent tampon that was later removed from the market.

Toxic shock syndrome is still mostly a disease of menstruating women who use tampons. But it has also been linked to the use of menstrual sponges, diaphragms, and cervical caps. A woman who has recently given birth also has a higher chance of getting toxic shock. And it can happen to men and women who have been exposed to staph bacteria while recovering from surgery, a burn, an open wound, or the use of a prosthetic device.

More than one-third of all cases of toxic shock involve women under 19, and up to 30% of women who have had the disease will get it again. If you have ever had toxic shock, you must look out for the symptoms so you can get immediate medical care.

People who die from toxic shock are killed by the body's response to the toxins released by staph bacteria. Most people suffer hypotensive shock, in which the heart and lungs stop working.

Some signs and symptoms of toxic shock syndrome to look out for include:

  • A high fever that spikes suddenly
  • Low blood pressure
  • Throwing up or frequent, watery stools
  • A rash that looks like a sunburn, especially on your palms and bottoms of your feet
  • Confusion
  • Muscle aches
  • Red eyes, mouth, and throat
  • Seizures
  • Headaches

If you’re menstruating and have a high fever with vomiting, especially if you‘ve been using tampons, you must get medical help right away. If you’re using a tampon, menstrual sponge, diaphragm, or cervical cap when you get ill, remove it immediately, even before calling your doctor.

Toxic shock syndrome is caused by a poison produced by Staphylococcus aureus bacteria. This bacteria is one of several staph bacteria that cause skin infections in burn patients and hospital patients who have had surgery.

Staph is normally -- and harmlessly -- present in the vagina. Doctors don’t know how toxins cause toxic shock syndrome. But two conditions are necessary: First, the bacteria need an environment in which they can grow rapidly and release poisons. Then the poisons must get into the bloodstream.

A tampon saturated with blood is a supportive place for rapid growth of bacteria. It also seems to matter what the tampon is made of. Polyester foam provides a better environment for the growth of bacteria than either cotton or rayon fibers.

In some cases resulting from menstrual sponges, diaphragms, and cervical caps, the device had been in the vagina for a long time -- more than 30 hours. In the case of sponges alone, pieces of the sponge remained in the vagina.

The way in which bacterial poisons enter the bloodstream may also be related to tampon use. Sliding a tampon into place could make microscopic tears in your vaginal walls, rupturing tiny blood vessels. Leaving a super-absorbent tampon in too long or using it when your flow is light can dry out your vagina. This makes tearing even more likely.

Researchers investigating toxic shock syndrome causes have ruled out feminine deodorant sprays and douches, underwear, and other clothing. The condition is also unrelated to your menstrual history, drug or alcohol use, cigarette smoking, swimming or bathing, or sexual activity.

There are several ways that doctors test for toxic shock syndrome:

  • Test blood and urine samples for a staph or strep infection.
  • Take a swab of your vagina, cervix, or throat.
  • Use a CT scan, lumbar puncture, or chest X-ray to show if toxic shock syndrome is affecting other organs in your body

If you have toxic shock syndrome, you’ll most likely need to go to the hospital where you could receive:

  • Antibiotics
  • Medicine for low blood pressure
  • Fluid to replace your body’s loss of water
  • Other supportive care

Show Sources


American Cancer Society. 

Toxic Shock Information Service. 


Mayo Clinic: “Toxic Shock Syndrome.”

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