Toxic Shock Syndrome


What is toxic shock syndrome (TSS)?

Toxic shock syndrome (TSS) is a rare but potentially life-threatening condition that is caused by certain strains of bacteria that produce toxins (poisons). It can result in the failure of vital organs, such as the liver, lungs or heart. Toxic shock syndrome was first identified in 1978 when a group of children became ill with it. In the early 1980s, cases of toxic shock syndrome were reported among women who used superabsorbent tampons during their menstrual periods. However, women who are not menstruating, men, and children may also contract toxic shock syndrome. Fifty percent of cases are non-menstrual. Skin wounds, surgical incisions, nasal packing, burns or gynecological procedures can increase the risk of the condition.

Symptoms and Causes

What causes toxic shock syndrome (TSS)?

The three main types of bacteria that can cause toxic shock syndrome are staphylococcus aureus, clostridium sordelli and streptococcus pyogenes. In many cases, these bacteria live on the skin or on the mucous membranes without causing any ill effects. However, under certain conditions, some strains of bacteria may start to grow rapidly and produce toxins .

Staphylococcus aureus bacteria may become trapped in the vagina when highly absorbent tampons are used and can enter the uterus via the cervix. Bacteria may grow on tampons, especially if they are not changed often enough. Bacteria also may grow if superabsorbent tampons are used when the menstrual flow is light. Tampons can also cause tiny cuts in the vagina through which bacteria can enter the bloodstream.

What are the symptoms of toxic shock syndrome (TSS)?

The onset of symptoms is usually sudden. Symptoms of toxic shock syndrome may vary depending on the type of bacteria that are producing the toxins. They may include:

  • Nausea or vomiting.
  • Sudden high fever and chills.
  • Watery diarrhea.
  • Rash resembling a bad sunburn or red dots on the skin.
  • Dizziness, light-headedness or fainting.
  • Low blood pressure (hypotension).
  • Redness in the eyes (conjunctivitis).
  • Peeling of the skin on the soles of the feet or palms of the hands.

Diagnosis and Tests

How is toxic shock syndrome (TSS) diagnosed?

Blood tests may be performed to rule out other bacterial or viral infections that may cause symptoms similar to those of TSS. Women will undergo a vaginal examination. Tissue cultures may be obtained from the vagina or cervix so they can be analyzed for the presence of staphylococcus aureus. For patients with wound or skin infections, tissue cultures may be collected at the site of the wound.

Management and Treatment

How is toxic shock syndrome (TSS) treated?

Patients should be hospitalized because of the potentially life-threatening nature of toxic shock syndrome. Any tampon or contraceptive device will be removed. Patients will be given intravenous (IV) fluids and possibly medications to raise their blood pressure if it is low.

The standard course for treating staphylococcus aureus infections involves intravenous (directly into the vein) administration of antibiotics. Antibiotics will help to control the growth of bacteria, but they will not eliminate the toxins that have accumulated in the body. In severe cases, patients may be treated with infusions of intravenous immune globulins.


How can toxic shock syndrome (TSS) be prevented?

  • Consider using sanitary pads instead of tampons during menstrual periods or use pads at night. Switching from tampons to pads every other day or during the times that the menstrual flow is heaviest may also help to reduce risk.
  • Women who use tampons during their menstrual periods should change them often. Tampons should be changed at least every four to eight hours. If the flow is heavy, tampons may have to be changed more frequently.
  • Use a tampon with the lowest absorbency required for your flow.
  • Do not use tampons when you are not menstruating.
  • Women who have recovered from a case of toxic shock syndrome should avoid using tampons during menstrual periods. Toxic shock syndrome is more likely to recur in women who have had it.
  • Make sure surgical incisions are kept clean to avoid infection. See your doctor if you notice unusual swelling, redness or heat near the wound.
  • Follow directions when using vaginal contraceptives such as sponges or diaphragms.

What factors increase the risk of toxic shock syndrome (TSS)?

Most of the cases of toxic shock syndrome are associated with the use of highly absorbent tampons. Women of childbearing age who use tampons during menstruation are at greater risk of developing it. The incidence of toxic shock syndrome is approximately one case per 100,000 menstruating women. It occurs most often among women age 15 to 25 years of age who use tampons. However, cases of toxic shock syndrome also occur among older women, men and children. Patients who have undergone surgery may develop wound infections that result in TSS. Among women, other risk factors include gynecological procedures, such as childbirth, induced or spontaneous abortions, and the use of birth control devices such as the diaphragm or contraceptive sponges. In general, the risk of developing TSS not associated with menstruation is about three times higher for women than for men.

Last reviewed by a Cleveland Clinic medical professional on 07/11/2018.


  • National Organization for Rare Disorders. Toxic Shock Syndrome. ( Accessed 11/18/2021.
  • U.S. Department of Health & Human Services, Office on Women’s Health. Menstruation and the menstrual fact sheet. ( Accessed 11/18/2021.
  • Lin Y, Peterson M. U.S. National Institutes of Health (NIH Public Access). New insights into the prevention of staphylococcal infections and toxic shock syndrome. ( 2010 Nov;3(6):753-767. Accessed 11/18/2021.

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