Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a rare but serious condition that happens when bacteria make toxins that get into your bloodstream.

You may hear about TSS most often when people talk about using tampons. But TSS can affect anyone. Skin wounds, surgical incisions, nasal packing or other areas of injured skin can all lead to TSS. You can get it when bacteria grow in a moist, warm environment (like your vagina). But bacteria can also enter your body through broken skin. These bacteria release toxins that eventually get into your blood. These toxins can damage organs, like your heart, liver or kidneys.

The symptoms of TSS happen suddenly and worsen quickly. But most people recover from it with a prompt diagnosis and treatment.

Symptoms of toxic shock syndrome

Symptoms of toxic shock syndrome may vary depending on the type of bacteria producing the toxins. Symptoms may include:

• Sudden high fever, chills, body aches and other flu-like symptoms
• Nausea or vomiting
• Watery diarrhea
• Rash resembling a bad sunburn or red dots on your skin
• Dizziness, lightheadedness or fainting
• Low blood pressure
• Redness in your eyes and throat
• Peeling of the skin on the soles of your feet or palms of your hands

Symptoms can begin within days of the toxins getting into your bloodstream.

Toxic shock syndrome causes

A toxin produced by Staphylococcus aureus (staph infection) and Streptococcus pyogenes (group A strep infection) causes most cases of toxic shock syndrome. Clostridium sordellii can also cause toxic shock syndrome, but it’s less common.

These bacteria typically live on your skin or in your throat or mouth without causing any problems. Problems can happen when the bacteria are trapped in one area. This makes the bacteria grow quickly and spread. The bacteria can release toxins, which make you sick once they get into your bloodstream.

Tampons create an environment where bacteria grow, especially if they stay in too long. These bacteria can release toxins that enter your bloodstream.

Leaving a tampon in too long isn’t the only way to get TSS. Anything that stays in your vagina too long can increase your risk. This includes cervical caps, diaphragms or menstrual cups.

TSS can also happen when bacteria get into open wounds, cuts or sores on your body. This can be from a skin infection, surgery or a nosebleed that requires packed gauze to stop it. Anytime bacteria are close to your skin, they can multiply and produce toxins.

How long can a tampon stay in before toxic shock?

There isn’t an exact time. But you should remove a tampon after eight hours. This doesn’t mean you will get TSS if you leave it for longer. But leaving a tampon in too long gives harmful bacteria more time to grow.

Can pads cause toxic shock syndrome?

Yes, you can still get toxic shock syndrome if you wear menstrual pads. It’s less common, but it can happen. This is because bacteria cause the condition, not the pad.

Risk factors

Most cases of toxic shock syndrome are linked to using tampons during your period. But TSS can happen to people who don’t use tampons. It can occur after surgery or from infections and skin wounds.

These factors can increase your risk:

• Using tampons, especially if they’re left in too long or are very absorbent
• Using diaphragms, cervical caps or menstrual cups
• Having a break in your skin (cuts, burns, insect bites or an open wound from surgery)
• Having surgery or giving birth
• Using nasal packing to treat a nosebleed
• Having a Staphylococcal or Streptococcal infection (like strep throat, impetigo or cellulitis)

How to lower your risk

Some steps you can take to lower your risk of TSS are:

• Use pads instead of tampons during your period, and use pads at night.
• Change tampons every four to eight hours.
• Use a tampon with the lowest absorbency you need.
• Don’t use tampons when you aren’t on your period.
• Keep surgical incisions clean to avoid infection.
• Follow directions when using vaginal contraceptives, like sponges, caps or diaphragms.

Toxic shock syndrome is more likely to occur in people who’ve already had it. You should avoid using tampons during your period if you’ve recovered from a case of TSS.

Complications of this condition

Toxic shock syndrome is serious and life-threatening. Symptoms can progress quickly, and immediate treatment is necessary.

Shock, organ failure, amputation of limbs and death can occur if toxic shock syndrome is left untreated.

How doctors diagnose TSS

A healthcare provider may use a combination of exams and tests to check for bacteria. These include:

• Blood or urine tests
• Swabs from your vagina, cervix or throat
• Tissue samples from a wound or infection

If your symptoms are severe or have progressed, your healthcare provider may order these tests to check the health of other organs:

• CT scan
• Chest X-ray
• Spinal tap

How is it treated?

Treatment usually happens in the hospital because the condition can be life-threatening. First, a healthcare provider will remove any tampons or contraceptive devices from your vagina if that’s the cause. You’ll get intravenous (IV) fluids and medications to raise your blood pressure if it’s low.

Treatment for the bacterial infection that causes TSS is antibiotics through an IV. This will help control the bacteria. But it will not stop the toxins from making you sick until your body clears them.

Other than antibiotics, other treatments for TSS may involve:

• Oxygen to help with breathing
• Fluids to prevent dehydration and organ damage
• Medicine to help control blood pressure
• Dialysis if your kidneys stop functioning
• Purified antibodies taken from donated blood (known as pooled immunoglobulin) to help your body fight the infection
• Surgery to remove dead tissue

When should I see my healthcare provider?

Contact your healthcare provider if you have signs of toxic shock syndrome, especially if you use tampons, have a skin wound or have recently had surgery.

Can you survive TSS?

Yes. While it can be serious, getting treatment right away improves your chances of making a full recovery.