Toxic Shock Syndrome

Medically Reviewed by Jabeen Begum, MD on October 11, 2023
6 min read

Toxic shock syndrome (TSS) is a sudden, potentially deadly condition caused when an overgrowth of bacteria releases toxins into your bloodstream.

Two kinds of bacteria, Staphylococcus aureus and Streptococcus pyogenes,are to blame for most cases. It's rare, and it usually comes from using tampons or having a cut or burn that gets infected.

If you get it, you'll need immediate medical care to prevent serious complications.

Depending on which kind of bacteria causes it, how quickly you get treatment, and your overall health, it can be fatal 30%-70% of the time.

When it starts, TSS causes the same symptoms as a lot of other less serious illnesses. They come on suddenly and include:

  • A high fever and chills
  • Muscle aches
  • Vomiting and diarrhea
  • Headache
  • Sore throat

Symptoms get worse fast, and you can also have:

  • Low blood pressure
  • A rash that looks like a sunburn, especially on your palms and bottoms of your feet
  • Red eyes, mouth, and throat
  • Confusion
  • Seizures

After about a week, the rash from TSS can cause your skin to peel in large sheets.

What does TSS feel like?

You may feel like you have the flu at first. But you'll quickly feel much sicker as the toxins from the infection start to damage your organs.Pay special attention to symptoms like a sudden high fever and vomiting if you're on your period or if you have an open wound or a skin infection. If you're using a tampon, menstrual sponge, diaphragm, or cervical cap when you get sick, take it out right away, even before you call the doctor.

Three different kinds of bacteria can cause TSS:

  • Staphylococcus aureus (staph)
  • Streptococcus pyogenes (group A strep)
  • Clostridium sordellii

Staph lives normally on many peoples' bodies without causing problems. But it's also responsible for a lot of infections in people with serious burns or who've had surgery. Group A strep causes many less-serious infections like strep throat and impetigo. Clostridium sordellii can also live harmlessly inside your vagina.

TSS happens when certain conditions allow these bacteria to grow and spread quickly and start releasing poisons. Then they get into your bloodstream through a break in your skin or mucus membranes.

Some things that can cause you to get TSS include:

  • Tampon or other device left inside your vagina for too long
  • Skin infection
  • Postsurgical infection
  • Childbirth, abortion, or other gynecological procedure
  • Gauze or other packing used to stop a nosebleed or surgical bleeding

Why do tampons cause TSS?

This condition made headlines in the late 1970s and early 1980s after the deaths of women who were using super-absorbent tampons. A saturated tampon is a place where bacteria can grow quickly. It can then travel into the uterus through the cervix.

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. It also seems to matter what the tampon is made of. Polyester foam is worse than either cotton or rayon fibers.

Sliding a tampon into place could make microscopic tears in your vaginal walls that can let bacteria in. Leaving a super-absorbent tampon in too long or using it when your flow is light can dry out your vagina, making tearing even more likely.

The kinds of super-absorbent tampons that were involved in the earlier cases aren't made anymore. And now tampon makers have to use standard labeling and measurements for absorbency, and include instructions for how to use them safely. Tampon-related cases of TSS have dropped since the '80s.

You're more likely to get TSS if you:

  • Use tampons, especially if they're super-absorbent or left in longer than recommended
  • Have broken skin from a cut, burn, or bug bite
  • Are recovering from surgery
  • Have a skin infection like impetigo or cellulitis
  • Have strep throat or a viral infection like the flu or chickenpox
  • Recently had a baby, a miscarriage, or an abortion
  • Use a diaphragm or other device that goes inside your vagina
  • Needed gauze packing to stop a nosebleed
  • Have had TSS before
  • Are very young, very old, have a weakened immune system, or a chronic medical condition

Doctors test for TSS in several ways:

  • Test blood and urine samples for a staph or strep infection.
  • Take a swab of your vagina, cervix, or throat.
  • Take a swab from an infected wound.
  • Test your blood for cell counts and enzyme levels that show how well your organs are working.
  • Measure how quickly your blood clots.
  • Use a CT scan, spinal tap, or chest X-ray to look for other signs TSS is affecting your organs.

TSS is an emergency situation, and you'll need to go to the hospital. You may be treated with:

  • Antibiotics given through a vein in your arm
  • Antibodies from donated blood to help fight the infection
  • Medicine for low blood pressure
  • Fluid to replace your body's loss of water
  • Extra oxygen

If the bacteria causing the TSS is coming from badly infected tissue, you may have to have surgery to remove it. You may need dialysis if your kidneys are damaged.

TSS can cause widespread damage in your body. You may go into shock, and your organs could shut down. Complications can include:

  • Kidney failure
  • Liver failure
  • Excessive bleeding because your blood won't clot correctly
  • Tissue death

The damage can be so serious that you might have to have fingers and toes or even limbs amputated. It can also be deadly.

TSS is rare, and you can take steps to make it less likely you'll get it.

  • Keep burns, cuts, and other skin injuries clean.
  • Follow your doctor's instructions for taking care of a surgical incision.
  • Call your doctor right away if you notice signs a wound is infected, like redness, pain, or swelling.

If you use tampons, use them correctly.

  • Wash your hands before putting one in.
  • Change tampons at least every 4-8 hours.
  • Don't use a product with a higher absorbency than you need.
  • Use pads instead of tampons some of the time.

Make sure your hands are clean before putting any other period product or birth control device into your vagina, and don't leave them in longer than recommended. If you've had TSS once, you're more likely to get it again, so your doctor may tell you not to use these kinds of products.

TSS is a rare, but very serious condition that can come from an infected cut or burn or from using tampons. Bacteria spread toxins through your bloodstream, which can cause major damage to your organs and even death. It comes on suddenly with symptoms like the flu and gets worse quickly.

  • What are the warning signs of TSS?

TSS starts out with mild flu-like symptoms that get worse fast. You should suspect it if you suddenly feel very sick all over your body, especially if you've been using tampons or have an infected cut or burn.

  • What are the major criteria of TSS?

According to the CDC, TSS involves a fever, a rash, a dramatic drop in blood pressure, and evidence of serious organ damage.

  • What is TSS typically caused by?

Infections from two bacteria, Staphylococcus aureus (staph) and Streptococcus pyogenes (group A strep), are responsible for most cases of TSS. They can get into your bloodstream through broken skin or mucus membranes. TSS can come from cuts, burns, or surgical incisions, or leaving tampons or other devices inside your vagina longer than recommended.