Toxic shock syndrome (TSS) is often associated with women and specifically women on their periods, but this rare and serious disease can affect anyone. In fact, according to the University of Utah’s Dr. Erin Clark, TSS affects 3-6 people per 100,000 person a year. TSS can be scary and is fatal for some who contract it, so we hope that with a few key facts and context for this disease, you’ll be well equipped to prevent it as much as possible, identify early signs, and get the right treatment at the right time.

What Is Toxic Shock Syndrome?

TSS is a potentially fatal illness caused by infection with certain types of bacteria, including Staphylococcus aureus and Streptococcus pyogenes.

These bacteria may live naturally in the body but the poisons (toxins) they produce that can cause TSS. For instance, Staphylococcus aureus (staph) is a common type of bacterium that lives on the skin and inside the nose; it’s often harmless. For TSS to occur, staph must first over-grow and make large amounts of the TSS toxin, which then enters the bloodstream.

How Can I Get Toxic Shock Syndrome?

TSS can affect anyone since the toxin-producing bacteria can enter anyone’s body via skin wounds, surgical incisions, nasal packing, scrapes, and burns.

Often, this infection stems from:
- Having cuts or burns on your skin
- Having had recent surgery
- History of recent childbirth, miscarriage, or abortion
- Using contraceptive sponges, diaphragms, superabsorbent tampons or menstrual cups
- Having a viral infection, such as the flu or chickenpox
- Having a more chronic condition such as diabetes, weak immune system, chronic lung disease, or heart disease

Toxic Shock Syndrome And Tampon Use

TSS from staph infections were first identified in the 1970s and 1980s when highly absorbent tampons were widely used. Super-absorbent tampons left in the body for long periods may encourage bacteria and toxins to replicate. Tampons can also stick to the vaginal walls, causing tiny abrasions when they are removed leading to harmful bacterial growth.

It’s important to note that because of changes in how tampons are made, the incidence of tampon-induced TSS has declined. In fact, the materials and designs that were associated with TSS are no longer used by US manufacturers.

Symptoms of Toxic Shock Syndrome

So you had a small cut that looks infected or forgot to change your tampon for 24 hours and you’re worried—should you be? Likely not. However, check the following list of TSS symptoms and if your concern continues, see your primary care provider:
- Fever
- Vomiting
- Diarrhea
- Skin rash that looks like sunburn
- Peeling patches of skin on the feet and hands
- Muscular aches
- Headaches
- Fatigue
- Shock
- Bleeding problems
- Abdominal tenderness
- Difficulty breathing
- Sore throat
- Red eyes
- Confusion and disorientation
- Drop in blood pressure
- Joint pains
- Sensitivity to light
- Kidney failure

The onset of symptoms is usually sudden and TSS often occurs within days of the bacteria invading your bloodstream. If you think you could have toxic shock syndrome, go to the emergency department of your nearest hospital.

How Is Toxic Shock Syndrome Diagnosed?

Your doctor will likely do one of the following to test you for TSS:
Blood cultures to help find harmful microorganisms
Blood and urine tests
Lumbar puncture to check the spine for bacteria

Since TSS can affect multiple organs, diagnosis may also include a CT scan or chest X-ray.

Treatment for Toxic Shock Syndrome

As with other illnesses, there’s no one-size-fits-all treatment for TSS. Instead, your doctor will assess treatment based on your age, health, and medical history, the extent of the disease, and your tolerance for specific medications. Treatment options may include:

• Antibiotics
• Surgical cleaning of an infected wound
• Heart medications in people with very low blood pressure
• Dialysis among people who develop kidney failure
• Supplemental oxygen to assist with breathing

How To Help Prevent Toxic Shock Syndrome

TSS is rare, however, prevention is always the first step in keeping yourself safe from infections and illness. We recommend the following steps to help prevent TSS:

If you have a cut or burn, look out for signs of infection, such as a rash, swelling, or pain and keep the area clean.
Toxic shock syndrome can recur, so if you’ve had it before, don't use tampons to help prevent reinfection.
Take care when using tampons, menstrual cups, contraceptive caps and diaphragms. Follow the instructions, do not leave tampons in longer than needed. If you use tampons, read the labels and use the lowest absorbency tampon you can. Change tampons frequently, at least every four to eight hours and use pads when your flow is light.
Wash your hands before and after using menstrual products.
Use a water-based lubricating jelly to help insert tampons on the last day or so of your period when your flow is light. This can minimize internal cuts or abrasions.