Toxic Shock Syndrome: Causes, Signs, & Symptoms

By John Bernard, MD
Medically reviewed checkmarkMedically reviewed
May 29, 2020

Toxic shock syndrome (TSS) is a rare but serious cluster of complications that develops after you’re infected by certain strains of bacteria. As the bacterial infection takes hold, toxins are released into the bloodstream, affecting internal organs like the liver, lungs, and heart. Because TSS impacts many systems of the body, early signs of toxic shock syndrome may be hard to distinguish from those of other infections. The condition advances rapidly and can be life-threatening if left untreated.

Many people believe that TSS can only be contracted by menstruating women who use highly absorbent tampons, but both men and women can develop toxic shock syndrome. Individuals who have an open wound or history of intravenous drug use, recently undergone surgery, childbirth, miscarriage or abortion, or a history of using menstrual cups, diaphragms, or contraceptive sponges are particularly at risk for developing toxic shock syndrome.

What Is Toxic Shock Syndrome?

Toxic shock syndrome (TSS) is a cluster of complications that occur when a bacterial infection releases toxins into the bloodstream, in turn impairing vital organs. The condition is rare but very serious and can cause internal damage, illness, and occasionally, death.

Toxic shock syndrome was first identified in 1978 when a group of children became ill with the condition. In the early 1980s, TSS became a commonly known disease after a large number of cases were reported among women using a new brand of highly-absorbent tampons.

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Since then, federal regulations and changes in tampon manufacturing technology have led to a decline in menstrual-related TSS. Although tampons are still associated with toxic shock syndrome, they aren’t the only way TSS can be contracted. Patients can develop TSS if they have an open wound or burn, have recently undergone surgery or childbirth, if they have a history of intravenous drug use, or if they use a diaphragm or contraceptive sponge. Today, less than three of every 100,000 people develop the condition, and half the cases are related to menstruation.

Toxic Shock Syndrome Symptoms

Because toxic shock syndrome impacts multiple systems within the body, signs of the condition can be widespread, and vary widely from individual to individual. Symptoms can also differ depending on the strain of bacteria causing the infection, but commonly include:

  • Sudden, high fever of over 102° F (38.9° C) in adults, or over 100° F (37.8° C) in children
  • Low blood pressure
  • Headache or fatigue
  • Nausea and vomiting or diarrhea
  • Body aches or chills
  • A toxic shock syndrome rash of red dots, or one that looks flat and red, like a sunburn
  • Large flakes of dry skin that shed from your palms and the soles of your feet
  • Redness in your eyes, mouth, or vagina
  • Decreased urine
  • Excessive bruising or bleeding
  • Swelling
  • Disorientation or shock
  • Difficulty breathing
  • Abdominal or pelvic pain
  • Very fast heart rate
  • Seizure

Toxic shock syndrome symptoms develop suddenly and progress rapidly. Patients who have recently suffered a skin injury or had surgery may begin to show signs of TSS within 12 hours. Women who are menstruating and using tampons may show symptoms within 3-5 days.

Toxic Shock Syndrome Causes

Toxic shock syndrome is caused by three strains of bacteria: Staphylococcus aureus, Streptococcus pyogenes, and Clostridium sordellii. Each bacteria infects specific at-risk groups differently and can lead to different patient symptoms and outcomes.

Staphylococcus aureus or “Staph” is the most common bacteria linked to TSS because it primarily infects women who are menstruating and using highly absorbent tampons. Although staph is naturally occurring on many people’s skin and in women’s vaginas, blood-soaked tampons or other vaginal devices like cervical caps or sponges provide a moist, supportive environment for bacteria to reproduce rapidly and to quickly enter a woman’s uterus and bloodstream.

Streptococcal toxic shock syndrome or “toxic strep”, caused by Streptococcus pyogenes, is a rare but very serious condition that impacts both children and adults around the world. It often begins as a secondary condition, affecting people who have recently had chickenpox, soft tissue infections, surgical procedures, or suffer from weakened immune systems.

Clostridium sordellii is a bacteria is naturally present in the vagina, but can enter the uterus during childbirth, miscarriage, abortion, and menstruation and cause toxic shock syndrome. It has also been found to cause TSS among intravenous drug users.

Can you get toxic shock syndrome from pads?

While super-absorbent tampons were linked to a group of toxic shock syndrome cases in the 1980s, changes in federal regulation and tampon manufacturing technology have greatly reduced women’s risk of developing TSS from tampons. Sanitary napkins or pads are not associated with toxic shock syndrome and can be used as an alternative to tampons by women who would like to reduce their risk of infection further.

How Do You Know If You Have Toxic Shock Syndrome?

Toxic shock syndrome is a rare but serious condition that can be life-threatening if left untreated. If you or someone you know is showing the signs and symptoms of toxic shock syndrome, call your doctor or visit the nearest emergency room immediately.

There isn’t a single test for toxic shock syndrome, so your doctor may use a variety of diagnostic tools to determine whether or not you are suffering from the condition. They may swab your vagina, cervix, and throat to check for infection. You may also undergo a blood test to determine how your vital organs are functioning, and your doctor may draw a sample of your spinal fluid via a lumbar puncture to check for bacteria. You may also be asked to submit a blood, urine, or stool sample to rule out other conditions.

If your doctor suspects that toxic shock syndrome has impaired your organs, they may order a CT scan or x-ray to get a better picture of your overall health and wellbeing.

Toxic Shock Syndrome Treatment

Toxic shock syndrome does not resolve on its own and can be life-threatening if left untreated. Patients who are diagnosed with the condition are hospitalized to receive adequate care. Toxic shock syndrome treatment plans may include:

  • Intravenous antibiotics to eradicate the infection
  • Removing any foreign bodies in the vagina that may be the source of the infection
  • Heart medication to treat low blood pressure
  • Fluids to treat dehydration and prevent shock
  • Supplemental oxygen to treat difficulty breathing
  • Dialysis to treat kidney failure
  • Surgery to clean an infected wound or remove dead tissue

Toxic Shock Syndrome Prevention

Federal regulations and changes in tampon manufacturing technology have greatly reduced women’s chances of developing toxic shock syndrome. That said, there are still precautions that you can take to reduce your risk of developing TSS:

  • Clean any open wounds, skin injuries, or burns: Prompt and thorough cleaning will help avoid infection. Call your doctor immediately if you experience any redness, swelling, or heat around your wound.
  • Choose the lowest absorbency tampons: If you use tampons, choose the lowest possible absorbency for your flow and change your tampon at least every 4-8 hours (more often if your flow is heavier). Never use tampons when you are not menstruating.
  • Consider alternatives to tampons: You can alternate using tampons with sanitary napkins or pads, or use menstrual cups. If you use a menstrual cup, sterilize it regularly. Additionally, follow all instructions when using diaphragms or contraceptive sponges.

Patients who have recovered from toxic shock syndrome are at a high risk of reinfection. Women and girls who have had TSS in the past should avoid using tampons.

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Risk Factors and Complications

Men, women, and children can develop TSS, but individuals who are at a higher risk include:

  • Those who have recently undergone surgery
  • Those who have suffered a wound or burn
  • Those who have a history of recent childbirth, miscarriage, or abortion
  • Those who have a history of using super-absorbent tampons, diaphragms, or contraceptive sponges
  • Those who have already had toxic shock syndrome

Because toxic shock syndrome develops rapidly, the complications from the condition can be severe. They include:

  • Liver failure
  • Kidney failure
  • Shock
  • Heart failure
  • Amputated fingers or limbs
  • Death

When to See a Doctor

Toxic shock syndrome is rare but can be life-threatening if left untreated. If you are experiencing any symptoms related to TSS, particularly if you have used a tampon or had surgery in the last 72 hours, call your doctor or visit the nearest emergency room immediately.

How K Health Can Help

If you think you have toxic shock syndrome, it’s important to get medical attention right away.

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

John Bernard, MD

Dr. Bernard is an emergency medicine physician. He graduated from Jefferson Medical College in Philadelphia, and did his residency in emergency medicine at the University at Buffalo.