Toxic shock syndrome
If you're a girl who's had her period, you may have heard
frightening stories about toxic shock syndrome (TSS), a
serious illness originally linked to the use of tampons. But
TSS isn't strictly related to tampons. The contraceptive
sponge and the diaphragm, two types of birth control
methods, have been linked to TSS. And, sometimes, the
infection has occurred as a result of wounds or surgery,
where the skin has been broken, allowing bacteria to enter.
Toxic shock syndrome can happen to anyone — men, women, and
children. Although it can be serious, it's a very rare
illness. If you're concerned about toxic shock syndrome, the
smartest thing you can do is to read and learn about it,
then take some precautions.
What Is Toxic Shock Syndrome?
TSS is a systemic
illness, which means that it affects the
whole body. It can be caused by one of two different types
Staphylococcus aureus and
— although toxic shock that is caused by the
bacteria is rarer. These bacteria can produce
toxinstoxins. In some people whose bodies can't fight these
toxins, the immune system reacts. This reaction causes the
symptoms associated with TSS.
When people think of TSS, they often think of tampon use.
That's because the earliest cases of the illness, back in
the late 1970s, were related to superabsorbent tampons.
Research led to better tampons and better habits for using
them — such as changing tampons more often. The number of
TSS cases dropped dramatically. Today about half of all TSS
cases are linked to menstruation.
Aside from tampon use, TSS has been linked to skin
infections that are typically minor and can be associated
with the chickenpox rash. TSS has also been reported
following surgical procedures, giving birth, and prolonged
use of nasal packing for nosebleeds — although all of these
What Are the Signs and Symptoms?
Symptoms of TSS occur suddenly. Because it's an illness that
is caused by a toxin, many of the body's organ systems are
affected. The signs and symptoms of TSS include:
high fever (greater than 102° Fahrenheit [38.8° Celsius])
rapid drop in blood pressure (with lightheadedness or
sunburn-like rash on the entire body
vomiting and diarrhea
severe muscle aches or weakness
bright red coloring of the eyes, throat, and vagina
headache, confusion, disorientation, or seizures
kidney and other organ failure
The average time before symptoms appear for TSS is 2 to 3
days after an infection with
although this can vary depending on the cause of the
Can I Prevent TSS?
The risk of getting TSS is already low. But you can reduce
it still further by simply following some common-sense
Clean and bandage any skin wounds.
Change bandages regularly, rather than keeping them on for
Check wounds for signs of infection. If a wound gets red,
swollen, painful, or tender, or if you develop a fever,
call your doctor right away.
If you're a girl whose period has started, the best way to
avoid TSS is to use sanitary napkins instead of tampons.
For girls who prefer to use tampons, select the ones with
the lowest absorbency that can handle your menstrual flow
and change them frequently. You can also alternate the use
of tampons with sanitary napkins.
If you've already had an episode of TSS or have been
S. aureus, don't use tampons or contraceptive devices
that have been associated with TSS (such as diaphragms and
What Do Doctors Do?
TSS is a medical emergency. If you think you or someone you
know may have TSS, call a doctor right away. Depending on
the symptoms, a doctor may see you in the office or refer
you to a hospital emergency department for immediate
evaluation and testing.
If doctors suspect TSS, they will probably start intravenous
(IV) fluids and antibiotics as soon as possible. They may
take a sample from the suspected site of the infection, such
as the skin, nose, or vagina, to check it for TSS. They may
also take a blood sample. Other blood tests can help monitor
how various organs like the kidneys are working and check
for other diseases that may be causing the symptoms.
Medical staff will remove tampons, contraceptive devices, or
wound packing; clean any wounds; and, if there is a pocket
of infection (called an abscess), a doctor may need to drain
pus from the infected area.
People with TSS typically need to stay in the hospital,
often in the intensive care unit, for several days to
closely monitor blood pressure, respiratory status, and to
look for signs of other problems, such as organ damage.
TSS is a very rare illness that's usually not fatal if
recognized and treated promptly.