Toxic Shock Syndrome

Warning: Toxic shock syndrome constitutes a medical emergency. You should seek immediate medical attention if you develop a rash, fever, and feel ill, particularly during menstruation and tampon use, or if you have had recent surgery.



Although not technically classified as a sexually transmitted infection, many of the symptoms of toxic shock syndrome (TSS) are easily mistaken for those of a true STI. It is a rare but serious illness that often involves fever, shock, and problems with proper function of several body organs. Initially, medical professionals believed that TSS was caused simply by the act of leaving a tampon inside the vagina for longer than the recommended period of time, but today less than half of current cases stem from such actions. We now know that TSS is also associated with skin infections, burns, and complications post-surgery; its effects also affect children, post-menopausal women, and men.

Causes and Risk Factors

The cause of toxic shock syndrome was discovered to be a toxin produced by certain types of Staphylococcus bacteria; related but separately classified is another condition referred to as toxic shock-like syndrome (TSLS), which can be caused by Streptococcal bacteria.

Risk Factors for TSS include:

  • Childbirth
  • Staphylococcus aureus infection, also known as a Staph Infection
  • Foreign bodies or packings (such as those used to stop nosebleeds)
  • Menstruation
  • Surgery
  • Tampon use (particularly if left in for longer than the recommended time period)
  • Use of barrier contraceptives such as a diaphragm or vaginal sponge
  • Post-surgical infection


Symptoms of TSS can include:

  • Confusion
  • Diarrhea
  • General ill-feeling
  • Headaches
  • High fever, possibly accompanied by chills
  • Low blood pressure
  • Muscle aches
  • Nausea and vomiting
  • Organ failure (usually in the kidneys or liver)
  • Redness of eyes, mouth, or throat
  • Seizures
  • Widespread red rash that looks similar to a sunburn; peeling of the skin will occur within 1-2 weeks after the rash, particularly on the palms of the hand or bottom of the feet

Tests and Treatments

Unfortunately there is no single test for toxic shock syndrome. Instead, the diagnosis will often be based upon the presence of several symptomatic criteria: fever, low blood pressure, a rash that peels after 1-2 weeks, and problems with the proper function of at least three organs. Alternatively, in some instances it may be possible to test for the presence of S. aureus bacteria through blood culture.

If toxic shock syndrome is detected, the next step involves working quickly to address the sources of bacteria; any foreign materials such as tampons, vaginal sponges, or nasal packing will be removed, and sites of infection will be drained and properly cleaned. The primary goal of TSS treatment is maintain important body functions, including:

  • Antibiotics for any infection (may be given through IV)
  • Dialysis (if severe kidney problems are present)
  • Fluids through a vein (IV)
  • Methods to control blood pressure

Prognosis and Prevention

With the statistic that toxic shock syndrome may be deadly in up to 50% of cases, it cannot be stressed enough that this condition is extremely serious and needs to be treated as such, both by the patient and the medical care provider. In regards to prevention, the easiest way to safeguard yourself against menstruation-related TSS is by avoiding the use of highly absorbent tampons, changing tampons frequently, and using tampons once in a while (instead of regularly) during menstruation.


Last updated 14 May 2014.