Toxic Shock Syndrome (TSS)

Toxic shock syndrome (TSS) is a rare, life-threatening condition commonly associated with tampon use, especially ones that are left in place for a long period of time or that are highly absorbent.

It can also occur with the use of contraceptive sponges and diaphragms.

Patients can be seen by Texas Children's experts in Pediatric and Adolescent Gynecology.

Causes & Risk Factors

Tampons themselves do not cause toxic shock syndrome. It is caused by bacteria that can grow when a tampon is left inside a woman’s vagina for too long.

While most often associated with tampon use, toxic shock syndrome can affect anyone, male or female, who has wounds, skin infections or incisions that bacteria has entered and released toxins.

Symptoms & Types

Toxic shock syndrome starts suddenly, with symptoms that may include:

• High fever
• Rapid drop in blood pressure, with fainting or lightheadedness
• A sunburn-like rash
• Peeling on the palms of the hands and soles of the feet after 1 to 2 weeks
• Nausea and vomiting
• Confusion
• Diarrhea
• General ill-feeling
• Headaches
• Muscle aches
• Redness of eyes, mouth, throat
• Redness, swelling and tenderness around a wound

If you suspect toxic shock syndrome, seek immediate medical attention. If you are wearing a tampon, remove it immediately.

Left untreated, organs such as the liver and kidneys may begin to fail.  In addition, seizures, bleeding, shock and heart failure may occur.

Diagnosis & Tests

Diagnosis may include:

• Physical exam
• Pelvic exam
• Tissue samples swabbed from the vagina for laboratory analysis
• Blood tests
• Urine tests

Treatment & Care

Because toxic shock syndrome can progress rapidly with life-threatening complications, treatment typically takes place in the hospital. The goal is to stop the infection while restoring the function of vital organs.

Treatment strategies may include:

• Removal of the source of the infection – such as a tampon, diaphragm, or contraceptive sponge
• Treatment for shock or organ failure
• Removal of infected tissue, in some cases
• Antibiotics to kill the bacteria that are producing the toxins
• IV fluids to treat dehydration caused by vomiting, fever and diarrhea
• Medications to stabilize blood pressure
• Monitoring of respiration, kidney and liver functions

Living & Managing

Prevention strategies include:

• Avoiding the use of tampons, or alternating between tampons and pads
• Washing your hands before inserting or removing tampons
• Frequent hand washing to prevent the spread of bacteria that causes toxic shock syndrome
• Using the lowest absorbency tampons possible for your flow
• Changing tampons every 4 to 6 hours, more often if needed
• Using tampons only when menstrual blood is present
• Storing tampons away from heat and moisture, where bacteria can grow