Toxic Shock Syndrome

What is Toxic Shock Syndrome?

Toxic shock syndrome is a serious, possibly life-threatening, complication that occurs as a result of an infection, usually caused by staph or strep bacteria.

It is a very rare condition, with only 337 cases appearing in the United States in 2015. Historically, it has often associated with the use of tampons, although its occurrence among menstruating women has dropped since certain tampons have been removed from the market.

Although toxic shock syndrome is often seen in women, the infection can actually affect anyone, including men, children, and postmenopausal women. The condition has also been linked to using diaphragms or contraceptive sponges, recent childbirth, having burns or cuts on the skin, going through a recent surgery, and having a viral infection like chickenpox or the flu.

What are the Symptoms of Toxic Shock Syndrome?

Toxic shock syndrome can set in quickly.

Symptoms include:

  • Confusion
  • Sudden severe fever
  • Diarrhea
  • Vomiting
  • Low blood pressure
  • Muscle aches
  • Rashes that look like a sunburn
  • Headaches
  • Redness in the eyes, throat, and mouth
  • Seizures
  • Abdominal pain
  • Fainting
  • Fatigue
  • Chills
  • Dizziness
  • Lightheadedness
  • Skin peeling
  • Rapid breathing
  • Decreased urination
  • Organ dysfunction

Left untreated, the infection can lead to serious complications including kidney failure, liver failure, heart failure, shock, and death.

Toxic Shock Syndrome Causes

Toxic shock syndrome (TSS) is caused when the toxins are released into the bloodstream from bacterial infections.

Causes include:

  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Clostridium sordellii

These bacteria can live on the skin (or in the case of C. sordellii in the vagina) harmlessly. However, when they enter the bloodstream they can have a toxic effect.

There are a number of ways that a bacterial infection can enter the bloodstream. It may be via surgical wounds or through infections in the skin or deep tissues caused by wounds or burns. However, TSS tends to be most commonly associated with the use of tampons.

It is not completely clear why tampons can cause TSS, but we do know that they provide a welcome breeding ground for bacteria when inserted into the vagina since they are moist and warm. It is thought that bacteria could pass from tampons into the bloodstream via tiny cuts or abrasions on the lining of the vagina, which could have been caused by irritation from tampon fibers.

Super-absorbent tampons tend to pose the most risk of TSS. Since they can absorb more menstrual blood, they could be left in the vagina much longer, which could allow more time for bacteria to multiply and enter the bloodstream.

How is Toxic Shock Syndrome Treated?

Patients who suspect they may be experiencing toxic shock syndrome need to seek immediate emergency medical treatment. In most cases, hospitalization is required so that doctors can monitor the condition and locate the source. Intravenous antibiotics will be given, with several weeks of oral antibiotics to continue upon leaving the hospital.

Further treatment is dependent on what is causing the condition. Doctors will remove any contraceptive or feminine hygiene item that is determined to be responsible, and open wounds will be drained to aid in clearing the infection. Severe cases may require the removal of infected tissue to prevent damage to surrounding healthy tissue.

Toxic Shock Syndrome Prevention

To prevent the risk of developing tampon-induced TSS, it is recommended to wear a tampon for no longer than 8 hours before removing it. If you are likely to sleep for more than 8 hours overnight, do not insert a tampon before you go to bed and use a sanitary pad or menstrual cup instead.

It’s also important to thoroughly wash the hands before inserting a tampon, as this can reduce the risk of transferring bacteria onto the tampon and into the vagina. You should avoid wearing tampons when not menstruating or when menstrual flow is very light, or avoid wearing a higher absorbency tampon than needed as this can increases the risk of tampon fibers irritating the lining of the vagina.

To minimize the risk of TSS from wounds, prompt and thorough wound care is vital. Serious burns, cuts or lacerations should be treated by a medical professional as soon as possible, and individuals who have recently had surgery should closely follow the wound care protocols given to them by their healthcare provider.

Last Reviewed:
October 11, 2016
Last Updated:
September 10, 2017
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