Information about Toxic Shock Syndrome (TSS)

Toxic shock syndrome (TSS)—most commonly linked to tampon use—is a reaction to bacterial toxins. The number of TSS cases in the United States peaked in the late 1970s and early 1980s among young women using certain brands of superabsorbent tampons and it has dropped dramatically since these tampons were taken off the market. TSS may be triggered by other causes and can affect older women, men and children as well. It is a potentially serious condition that requires prompt medical attention.

If left untreated, TSS can produce complications such as a severe drop in blood pressure (shock), or liver or kidney failure. Most patients recover fully with treatment in one to two weeks, but TSS can recur (for example, with subsequent menstrual periods), and in rare cases, it can be fatal. Overall incidence of TSS is now low, and in general, judicious tampon use is safe. However, women who use tampons during menstruation should be aware of the typical symptoms of TSS and should seek immediate medical attention if any of these symptoms appears.

What Causes Toxic Shock Syndrome?

  • Toxic shock syndrome is usually caused by Staphylococcus aureus bacteria, which produce toxins that are absorbed into the bloodstream. In the case of tampon-associated infection, the precise relationship between tampons and TSS is still in question; it is believed that tampon insertion may cause tiny breaks in the skin, which become infected or that superabsorbent tampons that are left in place too long may trap the bacteria in the vagina and provide a favorable environment for bacterial growth.
  • TSS may result from other Staph. aureus and streptococcal infections, occurring in conjunction with infected scrapes or burns, abscesses, osteomyelitis or postsurgical infections. Over the past 10 years, increasing numbers of TSS cases have been caused by streptococcal organisms—typically associated with an infected wound.

Symptoms of Toxic Shock Syndrome

  • Sudden, high fever (above 102°F)
  • Vomiting, nausea and diarrhea
  • A deep red rash, most often on the palms of the hands or soles of the feet. After one to two weeks, the skin begins to peel.
  • Aching or severe muscle pain
  • Headache
  • Bloodshot eyes
  • Sore throat
  • Vaginal bleeding or discharge
  • Low blood pressure
  • Dizziness, weakness, disorientation or fainting
  • Seizures

Toxic Shock Syndrome Prevention

  • Change tampons several times a day, or alternate tampons with sanitary napkins. Never use a tampon overnight or between menstrual periods.
  • Use lower-absorbency tampons.
  • If you have experienced TSS in the past, avoid using tampons altogether.
  • Clean and disinfect surface cuts and scrapes, and cover them with an antibiotic cream.
  • Change wound dressings often, or as directed by your doctor.

Diagnosis of Toxic Shock Syndrome

  • Patient history (including tampon usage) and physical examination are necessary.
  • Blood tests help to rule out other disorders that can cause similar symptoms.
  • Pelvic exam can be performed.
  • Vaginal tissue or discharge may be cultured to confirm the diagnosis.
  • Count of white and red blood cells and platelets can be tested.

How to Treat Toxic Shock Syndrome

  • If using a tampon, remove it immediately.
  • In most cases hospitalization and intravenous administration of antibiotics are required.
  • Intravenous fluid replacement is necessary for patients who have gone into shock.
  • Further treatment may be needed for the complications of TSS, such as renal failure.

When to Call a Doctor

  • EMERGENCY Seek medical help immediately if you experience the symptoms of TSS.


Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference

Simeon Margolis, M.D., Ph.D., Medical Editor

Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at

Published: 16 Sep 2011

Last Modified: 28 Jan 2015