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Bacterial & Viral Infections

Toxic Shock Syndrome

Lee este articuloToxic shock syndrome can happen to anyone — men, women, and children. Although it can be serious, it’s a very rare illness. If you’re concerned about toxic shock syndrome, the smartest thing you can do is to read and learn about it, then take some precautions.

What Is Toxic Shock Syndrome?

If you’re a girl who’s had her period, you may have heard frightening stories about toxic shock syndrome (TSS), a serious illness originally linked to the use of tampons. That’s because the earliest cases of the illness, back in the late 1970s, were related to super-absorbent tampons. Research led to better tampons and better habits for using them — such as changing tampons more often. The number of TSS cases dropped dramatically. Today about half of all TSS cases are linked to menstruation.

But TSS isn’t strictly related to tampons. The contraceptive sponge and the diaphragm, two types of birth control methods, have been linked to TSS. It also can happen if bacteria enter skin that’s broken from a cut or other wound, surgery, or a scald or burn; after giving birth; during a chickenpox infection; and from prolonged use of nasal packing for nosebleeds — although all of these are rare.

TSS is a systemic illness, which means that it affects the whole body. It’s caused by two types of bacteria, Staphylococcus aureus (often called staph) and Streptococcus pyogenes (often called strep), with most cases related to staph bacteria. These bacteria can produce toxins. In some people whose bodies can’t fight these toxins, the immune system reacts. This reaction causes the symptoms associated with TSS.

What Are the Signs and Symptoms?

Symptoms of TSS occur suddenly. Because it’s an illness that is caused by a toxin, many of the body’s organ systems are affected.

The signs and symptoms of TSS include:

  • high fever (greater than 102ºF [38.8ºC])
  • rapid drop in blood pressure (with lightheadedness or fainting)
  • sunburn-like rash that can be anywhere on the body, including the palms of the hands and soles of the feet
  • vomiting or diarrhea
  • severe muscle aches or weakness
  • bright red coloring of the eyes, mouth, throat, and vagina
  • headache, confusion, disorientation, or seizures
  • kidney and other organ failure

The average time before symptoms appear for TSS is 2 to 3 days after an infection with Staphylococcus or Streptococcus, although this can vary depending on the infection.

Can I Prevent TSS?

Your risk of getting TSS is already low. But you can lower it even more by following these common-sense precautions:

  • Clean and bandage any skin wounds.
  • Change bandages regularly rather than keeping them on for several days.
  • Check wounds for signs of infection. If a wound gets red, swollen, painful, or tender, or if you develop a fever, call your doctor right away.
  • If you’re a girl whose period has started, the best way to avoid TSS is to use pads instead of tampons.
  • For girls who prefer to use tampons, select the ones with the lowest absorbency that can handle your menstrual flow and change them often. You also can alternate the use of tampons with sanitary napkins. If your flow is light, use a pad instead of a tampon. Store tampons away from heat and moisture (where bacteria can grow) — for example, in a bedroom rather than in a bathroom closet. And because bacteria are often carried on hands, wash your hands thoroughly before and after inserting a tampon.
  • If you’ve already had an episode of TSS or have had a serious staph or strep infection, don’t use tampons or contraceptive devices that have been associated with TSS (such as diaphragms and contraceptive sponges).

What Do Doctors Do?

TSS is a medical emergency. If you think you or someone you know may have TSS, call a doctor right away. Depending on the symptoms, a doctor may see you in the office or refer you to a hospital emergency department for immediate evaluation and testing.

If doctors suspect TSS, they will probably start intravenous (IV) fluids and antibiotics as soon as possible. They may take a sample from the suspected site of the infection, such as the skin, nose, or vagina, to check it for TSS. They also may take a blood sample. Other blood tests can help show how various organs (like the kidneys) are working and check for other diseases that might be causing the symptoms.

Medical staff will remove tampons, contraceptive devices, or wound packing; clean any wounds; and, if there is a pocket of infection (called an abscess), a doctor may need to drain pus from the area.

People with TSS usually need to stay in the hospital, often in the intensive care unit (ICU), for several days so doctors can monitor their blood pressure and breathing and watch for signs of other problems, such as organ damage.

TSS is a very rare illness. Although it can be fatal, if recognized and treated promptly it is usually curable.

Reviewed by: Larissa Hirsch, MD
Date reviewed: June 2014