Toxic shock syndrome (TSS)

Toxic shock syndrome (TSS) is an uncommon but life-threatening condition caused by bacterial infection getting into your bloodstream.

Key points about toxic shock syndrome (TSS)

  1. Anyone at any age can get toxic shock syndrome (TSS), but it is more common in women who are having periods and using tampons.
  2. TSS is a serious illness and requires immediate medical attention.
  3. Symptoms come on quickly and get worse quickly. They include fever, chills, widespread sunburn-like skin rash and flu-like symptoms. 
  4. TSS can be fatal if not treated promptly. But if it's diagnosed and treated early, most people make a full recovery.
  5. You can reduce your risk of TSS through hand washing and good personal hygiene when you have a period.

What are the symptoms of TSS?

The symptoms of TSS usually start suddenly and become worse quickly, especially if treatment is not started promptly. The symptoms are similar to other conditions. Seek immediate medical help if you have any of the symptoms below, because TSS can quickly result in the failure of vital organs, such as your liver, lungs or heart. 

Toxic shock syndrome is a medical emergency.

Seek immediate medical help, go to the nearest emergency department or contact your GP if you or the person you are caring for has any of these symptoms, especially if you feel ill during or soon after your period or have had recent surgery:

  • a high fever and chills
  • widespread sunburn-like skin rash
  • flu-like symptoms such as headache, muscle ache, sore throat, cough, fatigue
  • feeling sick or being sick (vomiting)
  • runny poos (diarrhoea)
  • shortness of breath and difficulty breathing
  • confusion
  • red eyes
  • dizziness, fainting or collapse.

Call Healthline free on 0800 611 116 if you are unsure what to do. 

If you're wearing a tampon, remove it straight away. Also tell your doctor if you've been using a tampon, recently had a burn or skin injury, or if you have a skin infection such as a boil.

What causes TSS?

Toxic shock syndrome (TSS) happens when bacteria called Staphylococcus aureus (often called Staph) and Streptoccocus pyogenes (often called Strep) release harmful toxins into your bloodstream. These bacteria usually live harmlessly on your skin or inside your nose or vagina.

However, if they get into your bloodstream, injured skin such as cuts and scrapes, surgical wounds and even chickenpox blisters, they can cause severe and life-threatening infections, such as sepsis and toxic shock syndrome. 

TSS is not spread from person to person. You do not develop immunity to it once you've had it, so you can get it more than once.

Who is most at risk of TSS?

Anyone at any age can get TSS, but it is more common in women who are having periods and using tampons. It is unclear why that happens, but it is believed that tampons can increase the risk of the bacteria entering your bloodstream through the cervix or vagina.

Other risk factors include:

  • the use of contraceptive devices such as a diaphragm or contraceptive sponges
  • recent childbirth, miscarriage or abortion
  • burns
  • wound packing or infection after surgery
  • nasal packing to stop nosebleeds
  • recent staphylococcal or streptococcal infections such as sore throatcellulitispneumonia, osteomyelitis, sinusitis or skin wounds
  • menstrual cups and female barrier contraceptives


How is TSS treated?

TSS gets worse very quickly and can be fatal if not treated promptly. But if it's diagnosed and treated early, most people make a full recovery. If you have TSS, you will need to be admitted to the hospital for treatment. Treatment can include:

  • removal of infection sources such as tampons, nasal pack or diaphragm
  • antibiotics (IV or oral) to treat the infection
  • often intravenous fluids, given through a drip
  • sometimes oxygen.

What is the outlook for someone with TSS?

About 5–15 % of people who get TSS die. In 30–40% of cases, you can get toxic shock syndrome again if you have previously had the condition. 

How can I prevent TSS?

There are ways to prevent TSS. 

In general

  • Wash your hands regularly.
  • Take good care of your wounds.
  • Use good hygiene practices when inserting anything in your vagina.
  • See a doctor if you notice signs of infection such as redness, swelling or pain around a wound.

If you are using tampons

Maintaining good personal hygiene when you have your periods can reduce your risk of TSS. 

  • Wash your hands thoroughly before and after you change your tampon.
  • Only use one tampon at a time.
  • Change your tampon regularly (use directions on the pack, eg, every 4–8 hours).
  • Take your tampon out before you go to sleep.
  • Don't force your tampon in as it can cause cuts to your vagina.
  • Use the tampon right after you unwrap it – having it unwrapped for too long can increase the chances of bacteria sticking around.
  • Use a tampon with the lowest absorbency you need.
  • Alternate between tampons, pads or panty liners during your period, eg, use pads instead of tampons overnight.
  • Remember to remove your last tampon after your periods.
  • Avoid using tampons or contraceptive devices such as a diaphragm if you have had TSS before. 

Learn more

Toxic shock syndrome Ministry of Health, NZ
Toxic shock syndrome NHS, UK

References

  1. Toxic shock syndrome Ministry of Health, NZ
  2. Toxic shock syndrome DermNet, NZ
  3. Toxic shock syndrome Better Health Channel, Victoria
  4. Ross A, Schoff HW. Toxic shock syndrome  NCBI, US, 2019 
  5. van Eijk AM, Zulaika G, Lenchner M. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis The Lancet. 2019 Aug 1; 4(8): E376-E393.

Reviewed by

Dr Helen Kenealy is a geriatrician and general physician working at Counties Manukau DHB. She has a broad range of interests and has worked in a variety of settings including inpatient rehabilitation, orthgeriatrics and community geriatrics.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Helen Kenealy, geriatrician and general physician, Counties Manukau DHB Last reviewed: 14 Sep 2020