Overview

Toxic shock syndrome is a rare, life-threatening complication of certain types of bacterial infections. Often toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but the condition may also be caused by toxins produced by group A streptococcus (strep) bacteria.

Toxic shock syndrome can affect anyone, including men, children and postmenopausal women. Risk factors for toxic shock syndrome include skin wounds, surgery, and the use of tampons and other devices, such as menstrual cups, contraceptive sponges or diaphragms.

Symptoms

Possible signs and symptoms of toxic shock syndrome include:

  • A sudden high fever
  • Low blood pressure
  • Vomiting or diarrhea
  • A rash resembling a sunburn, particularly on your palms and soles
  • Confusion
  • Muscle aches
  • Redness of your eyes, mouth and throat
  • Seizures
  • Headaches

When to see a doctor

Call your doctor immediately if you have signs or symptoms of toxic shock syndrome. This is especially important if you've recently used tampons or if you have a skin or wound infection.

Causes

Most commonly, Staphylococcus aureus (staph) bacteria cause toxic shock syndrome. The syndrome can also be caused by group A streptococcus (strep) bacteria.

Risk factors

Toxic shock syndrome can affect anyone. About half the cases of toxic shock syndrome associated with staphylococci bacteria occur in women of menstruating age; the rest occur in older women, men and children. Streptococcal toxic shock syndrome occurs in people of all ages.

Toxic shock syndrome has been associated with:

  • Having cuts or burns on your skin
  • Having had recent surgery
  • Using contraceptive sponges, diaphragms, superabsorbent tampons or menstrual cups
  • Having a viral infection, such as the flu or chickenpox

Complications

Toxic shock syndrome can progress rapidly. Complications may include:

  • Shock
  • Renal failure
  • Death

Prevention

Manufacturers of tampons sold in the United States no longer use the materials or designs that were associated with toxic shock syndrome. Also, the U.S. Food and Drug Administration requires manufacturers to use standard measurement and labeling for absorbency and to print guidelines on the boxes.

If you use tampons, read the labels and use the lowest absorbency tampon you can. Change tampons frequently, at least every four to eight hours. Alternate using tampons and sanitary napkins, and use minipads when your flow is light.

Toxic shock syndrome can recur. People who've had it once can get it again. If you've had toxic shock syndrome or a prior serious staph or strep infection, don't use tampons.

March 18, 2020
  1. Kellerman RD, et al. Toxic shock syndrome. In: Conn's Current Therapy 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed Feb. 6, 2020.
  2. Toxic shock syndrome. Merck Manual Professional Version. https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-cocci/toxic-shock-syndrome-tss. Accessed Feb. 5, 2020.
  3. Nonfoux L, et al. Impact of currently marketed tampons and menstrual cups on Staphylococcus aureus growth and toxic shock syndrome toxin 1 production in vitro. Applied and Environmental Microbiology. 2018; doi:10.1128/AEM.00351-18.
  4. Cohen J, et al. Dermatologic manifestations of systemic infections. In: Infectious Diseases. 4th ed. Elsevier; 2017. https://www.clinicalkey.com. Accessed Feb. 5, 2020.
  5. The facts on tampons — and how to use them safely. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/facts-tampons-and-how-use-them-safely. Accessed Feb. 6, 2020.

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