Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a disease that is caused by substances called toxins. The toxins that cause TSS may be made by three different types of bacteria. The toxins get into the bloodstream and damage many vital organs. Fever, rash, swelling of the hands and feet, shock, heart failure, kidney failure, liver failure, and lung damage have all been associated with TSS. TSS can also cause blood clotting and bleeding problems. TSS can be life-threatening.


TSS occurs when one of three bacteria (Staphylococcus aureus, Streptococcus pyogenes, or Clostridium sordelli) enter the body through breaks or cracks in the skin or other tissue. The bacteria then produces toxins which enter the bloodstream and cause damage to many organs of the body.

Staphylococcal TSS is caused by the bacteria Staphylococcus aureus. It can occur in menstruating women. Risk for this disease increases in women who use:

  • High absorbency tampons.

  • Diaphragms.

  • Sponges.

  • Cervical caps.

Tampons can cause scrapes on the vaginal wall. This damage allows bacteria to enter into the vaginal wall. Super absorbent tampons are more harmful because they expand so much that they actually stick to the vaginal wall. When the tampon is removed, a layer of the vaginal lining may be scraped or peeled off. About half of all episodes of staphylococcal TSS occur in men, children, and menopausal women. In these cases, skin wounds or recent surgical cuts (incisions) are the site of entry for the bacteria.

Streptococcal TSS is caused by the bacteria Streptococcus pyogenes. It may occur in healthy or ill children and adults of any age. The entry site of the bacteria into the body may not show obvious signs of infection. This disease can follow minor injuries such as blood clots under the skin, bruises, and muscle strain. It may also occur following chickenpox or a surgical procedure. People who have diabetes or alcoholism seem to be at increased risk for this disease. Streptococcal TSS may also occur suddenly following childbirth.

Clostridial TSS is caused by the bacteria Clostridium sordelli. This bacteria is naturally present in the vagina. The bacteria may enter a woman's tissue and cause this disease following childbirth, abortion, or a procedure or surgery on a woman's sexual organs.


Signs of an infection (warmth, redness, swelling, pain, or fluid drainage) where the bacteria entered the body may or may not be found. Symptoms of TSS may include:

  • High fever.

  • Vomiting.

  • Diarrhea.

  • Sunburn-like rash.

  • Low blood pressure.

  • Muscle aches and pains.

  • Headaches.

  • Sore throat.

  • Bloodshot eyes.

  • Confusion.

  • Swelling or peeling of the skin on the palms and soles of the feet.

  • Increase in heart rate.


Your caregiver may perform some of the following tests to determine whether you have TSS:

  • Blood tests.

  • Blood, wound, and skin sample cultures.

  • Cultures from the vagina, mucus (sputum), and throat.

  • Chest X-rays.

  • Analysis of urine (urinalysis).

  • Lumbar puncture to check the spinal fluid.


Hospitalization is usually required. There is no way to predict which individuals with early TSS will develop severe medical problems. People who get proper treatment usually get better within 2 to 3 weeks. Treatment may include:

  • Immediate removal of the tampon, diaphragm, sponge, or cervical cap, if this applies.

  • Antibiotic medicines. Antibiotics may be given through an intravenous (IV) access.

  • IV fluids and medicines to raise low blood pressure and to replace fluids and body salts (sodium, potassium) lost from vomiting or diarrhea.

  • Dialysis if there is severe kidney involvement. A kidney transplant may be necessary in rare cases.

  • Surgery to remove infected tissue. This is rare, except in some cases of streptococcal TSS.


  • Follow recommended tampon guidelines.

  • Avoid super absorbent tampons.

  • Alternate the use of tampons with sanitary napkins or pads during your period. Use tampons during the day and pads at night.

  • Never leave a tampon inserted overnight.

  • Change tampons often, at least every 4 to 6 hours.

  • Do not leave in diaphragms, sponges, or cervical caps longer than instructed on the label.

  • Wash your hands with soap and warm water before inserting and removing a tampon, diaphragm, sponge, or cervical cap.

  • When inserting a tampon, be extremely careful not to scratch the vaginal lining. Plastic applicators may cause an increased risk because of the sharp edges produced when opening the applicator. If your vagina seems dry, use a water-soluble lubricating jelly. This will ease insertion.

  • Do not use a tampon between periods. It may dry out the vagina.

  • Use 100% cotton tampons instead of those made with synthetic materials.

  • Always choose the tampon with the least absorbency to meet your needs.

  • At the first sign of a fever or rash, remove the tampon immediately.

  • Do not leave your diaphragm or sponge in for longer than 12 hours.

  • Do not use tampons, a sponge, a cervical cap, or a diaphragm for 12 weeks after delivering a baby.

  • Do not use gauze packing for a nosebleed.

  • Wash cuts and scrapes with warm water and soap.

  • Keep scrapes and cuts covered to prevent infection from developing.


  • Take your antibiotics as directed. Finish them even if you start to feel better.

  • Women who had TSS should not use tampons ever again.


  • You have chills, vomiting, diarrhea, or a rash.

  • You have a convulsion or faint.

  • You have a cut or surgery and the skin around the wound becomes red, swollen, or drains pus.

  • You have a fever.

  • You have red streaks on the skin coming from an injury, piercing, or tattoo.

  • You just had a baby, within 12 weeks, and one of your children has strep throat.