Toxic Shock Syndrome: Symptoms, Treatment, and Prevention

Medically Reviewed by Carol DerSarkissian, MD on September 13, 2023
5 min read

Toxic shock syndrome (TSS) is a rare but serious condition that’s caused when your immune system reacts to toxins produced by bacteria. TSS occurs when these toxins enter into your bloodstream, where your body’s reaction  can affect many systems in your body at once.

TSS can be life-threatening, but with the right treatment, it’s also curable. That means it’s important to know its signs and symptoms so you can spot it and treat it quickly.

The symptoms are a lot like ones you might see from other kinds of infections: swelling, fever, redness, and a general feeling of being unwell.

TSS symptoms usually come on quickly, about 2 days after the bacteria infects you. The way TSS affects your body depends on the type of bacteria causing your condition.

Generally, TSS causes:

In order to figure out what kind of TSS you have, and to rule out other causes of infection or disease, your doctor will check for symptoms that are specific to certain types of bacteria. The bacteria that most commonly cause TSS are:

  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Clostridium sordellii (C. sordellii)

Staphylococcal TSS symptoms

Staphylococcal TSS happens most often in women. Sometimes, you can get it if you use super-absorbent tampons, and the bacteria gets trapped for too long in your vagina. You’re also more at risk if you have an infection after surgery, childbirth, or have burns or pus buildup in your body. This type of TSS causes:

You may also start to shed your skin in sheets, usually on the palms of your hands or soles of your feet, 1 to 2 weeks after your symptoms start.

Streptococcal TSS symptoms

This kind of TSS usually happens after you have chickenpox, a skin infection, or if you have a weak immune system. The first symptom is most often severe pain that comes on suddenly. Other symptoms include:

  • Very low blood pressure
  • Shock (not enough blood flow to the systems in your body)
  • Bleeding problems
  • Bruising
  • Flat, red rash like a sunburn on most of your body
  • Trouble breathing

You may also have sheets of skin shed off, like in staphylococcal TSS, but this doesn’t always happen.

C. sordellii TSS symptoms

Clostridium sordellii infection happens in the uterus. You can also get it from IV drug use. Its symptoms include:

Unlike the other most common types of TSS, such as staphylococcal TSS, C. sordellii does not usually cause a fever.

Call 911 if you or another person shows signs of shock, especially if you have used tampons, a diaphragm, or contraceptive sponge or if you have a skin wound or infection.

Because TSS can be life-threatening, you will probably need to get treatment in a hospital.

Doctors will do an exam and blood tests. They can keep an eye on your condition as they treat the TSS and its symptoms. You may have to stay there for a few days or longer, depending on how severe your case is.

Before choosing a treatment for you, your doctor will need to examine you to find out more about:

  • Your age and medical history
  • Your recent health history, including what might be causing your TSS
  • What kind of symptoms you’re having
  • How serious your symptoms are
  • How you react to certain medications or treatments

Your doctor may have to run tests or collect tissue or blood samples in order to figure out the specific treatments that will work for you. You may need:

IV antibiotics. This is the most common way doctors treat TSS. Antibiotics will help stop the bacteria from growing in your system. They do not get rid of the toxins that have built up in your body. The type of antibiotic you get depends on which kind of bacteria is causing your TSS.

Immunoglobulin therapy. If your TSS is very severe, your doctor may try to treat it with immunoglobulin. It’s a part of blood plasma that has antibodies. You get it through an IV. Immunoglobulin therapy can help boost your body’s defense systems against infection.

You may also need treatment for the symptoms of TSS, such as:

Depending on what caused your TSS, your doctor may want to:

  • Take out any tampons or other contraceptive devices
  • Clean any wounds
  • Drain pus from infected areas

If you have an infection that is very severe, you may have to have surgery to remove dead tissue and deep clean your wound to get rid of all of it.

TSS is rare. You’re unlikely to get it if you’ve never had it. But once you get it, you’re at a higher risk of getting it again. You can take these steps to keep your chances as low as possible:

  • If you get a wound, keep it clean, dry, and bandaged. Make sure to change your bandages regularly.
  • Any time you see signs of infection in a wound -- redness, swelling, pain, fever -- tell your doctor as soon as possible so it can be treated.

Be careful when you use tampons, diaphragms, or contraceptive sponges. All three carry some risk of TSS. If you’ve had TSS before, or if you’ve had a serious bacterial infection, you’re at a greater risk of getting TSS, and shouldn’t use them at all.

Because of improved designs, the risk of getting TSS from tampons is much lower than it used to be. But it’s still important to practice good tampon hygiene. To use tampons safely and reduce your risk of TSS:

  • Use the lowest absorbency tampon you can.
  • Change your tampon frequently -- every 4 to 6 hours or more, depending on your flow.
  • Use pads on light flow days.
  • Don’t use tampons when you don’t have your period.
  • Keep your tampon box in a cool, dry place to keep bacteria from growing.
  • Always wash your hands before putting a tampon in or taking one out.