Table of ContentsView AllTable of ContentsSymptomsRisk FactorsCausesDiagnosisTreatmentPrevention

Table of ContentsView All

View All

Table of Contents

Symptoms

Risk Factors

Causes

Diagnosis

Treatment

Prevention

While toxic shock syndrome is often associated withtampon use, tampons are not the only cause. The condition also affects people who are not menstruating, including people of all genders and ages.

This article explains TSS symptoms, causes, diagnosis, and treatment.

Toxic shock syndrome symptoms

Symptoms of Toxic Shock Syndrome

There are several signs and symptoms of TSS, including toxic shock syndrome rash and fever. The symptoms also depend on the type of bacteria responsible for the infection.

Symptoms of toxic shock syndrome usually come on suddenly and include:

When you develop TSS due to an injury or after having surgery, you may have additionalinfection symptoms, including pain, redness, swelling, and discharge (pus).

Toxic shock syndrome is a life-threatening infection and requires immediate medical attention. Left untreated, it can lead to shock, coma, permanent organ damage, and death.

Risk Factors for Toxic Shock Syndrome

Some situations can make a person more at risk for developing the infections that cause TSS, including:

It is important to note that a person who has had toxic shock syndrome before can get it again. That is why people who menstruate should avoid tampons to limit the risk of recurrence.

Causes of Toxic Shock Syndrome

Three kinds of bacteria cause TSS:

This immune system over-activation leads to the symptoms of toxic shock syndrome. Untreated, the response overwhelms the body to the extent that multi-system organ failure and even death can occur.

Toxic Shock Syndrome Rash

On the other hand, infections fromstaphylococcalbacteria usually have a rash and are more commonly associated with tampon use.

Toxic shock syndrome is linked to tampon use. The most considerable risk associated with tampons and TSS is how long they are left in. Super-absorbent tampons present a higher risk because they are typically worn for longer periods of time.

Thus, you should avoid super-absorbent tampons, if possible, and use the lowest absorbency possible. Look for the right absorbency for your flow rather than the one that will last the longest.

Toreduce your risk of TSSfrom tampon use:

Tampon use itself does not cause toxic shock syndrome. However, using tampons (especially if not changing them for prolonged periods) is an identified risk factor for developing astaphylococcalinfection that could lead to TSS.

Can Menstrual Cups Cause Toxic Shock Syndrome?Although it is rare, it is possible for a menstrual cup to cause TSS. To reduce the risk, ensure your menstrual cup is sanitized properly between uses.

Can Menstrual Cups Cause Toxic Shock Syndrome?

Although it is rare, it is possible for a menstrual cup to cause TSS. To reduce the risk, ensure your menstrual cup is sanitized properly between uses.

Non-Menstrual Causes

While most toxic shock syndrome cases are associated with menstruation, it also occurs in people who are not menstruating (non-menstrual TSS). Non-menstrual causes include:

As awareness of TSS related to menstruation improves, the non-menstrual causes of TSS are increasing.Often,streptococcalinfections that can result in toxic shock syndrome occur in people who are otherwise healthy but who are recovering from a medical procedure, injury, or viral illness.

Diagnosing Toxic Shock Syndrome

People of all ages can develop toxic shock syndrome. In the United States, toxic shock syndrome occurs in up to three per 100,000 menstruating people every year.But, it also occurs in men, children, and women who do not menstruate for any reason.

While it’s rare, the condition can be life-threatening—even in previously healthy people. In addition, the fatality rate ofstreptococcalTSS (STSS) can be more than 30%.Therefore, prompt diagnosis and treatment are critical.

The initial symptoms will depend on the bacteria causing the infection. In general, if a person has a high fever and rash that came on quickly and they also recently gave birth, had surgery, or used tampons, a healthcare provider may suspect toxic shock syndrome as the cause. Symptoms of TSS can set in within 12 hours.

The CDC set the following criteria to help diagnose toxic shock syndrome:

In addition to the above criteria, a person must test negative for several conditions that can cause similar symptoms, includingmeaslesandtick-borne illnessessuch as Rocky Mountain spotted fever.

Tests

As toxic shock syndrome results from the body’s overreactive immune response to an infection, there is no specific test for the condition. Instead, a healthcare provider will assess your clinical symptoms and risk factors.

Several tests can confirm the presence of infection and identifystreptococcalandstaphylococcalbacteria. These include:

Multiple blood tests and cultures may be necessary to determine the source and cause of the infection. For example, a person’s blood test may be negative forstreptococcalbacteria, but a culture taken from a skin wound may be positive forstaphylococcalbacteria.

Even if a case of TSS is deemed “probable” (meaning it meets all but one diagnostic criterion) but is not yet “confirmed” according to CDC criteria, immediate, intensive medical intervention is needed to prevent potentially life-threatening complications.

People with TSS often require hospitalization and may spend time in theintensive care unit(ICU).

Treatment of Toxic Shock Syndrome

While toxic shock syndrome is uncommon, accurate and timely diagnosis and prompt treatment are essential. That’s because it can take a couple of hours to a couple of days for the condition to turn life-threatening. People with the illness will require hospitalization.

Antibiotics

Broad-spectrumantibiotics, which may need to be given intravenously, are the standard treatment for toxic shock syndrome.

However, the exact medications will depend on the bacteria causing the infection and its location. For example, FDA-approvedoritavancin(Orbactiv) treats bacterial infections in skin wounds.

Some bacteria have grown resistant to antibiotics, so you may need multiple medications to treat the infection and prevent complications from TSS. The standard treatment course is at least ten days. Depending on the severity of the infection and whether complications arise, you may need more prolonged treatment or additional treatment.

Supportive Treatments

While being treated for the underlying infection, you may also receive supportive measures to help with symptoms like pain and dehydration. These interventions may include:

Preventing Toxic Shock Syndrome

Once you’ve had toxic shock syndrome, you are at risk of developing it again. Therefore, if you menstruate, your healthcare provider will likely advise you to avoid using tampons and menstrual cups.

There is no vaccine or specific treatment that will prevent toxic shock syndrome. The best prevention course is to avoid known risks of developing the condition. Helpful tips to prevent TSS include:

Summary

Prompt diagnosis and treatment are crucial because TSS can be fatal. Healthcare providers diagnose the condition using blood tests, cultures, and lumbar punctures. First-line treatment is antibiotics and other supportive care. If you have TSS, you will be hospitalized while you receive treatment.

Tampon Safety and Regulations

11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Library of Medicine.Toxic shock syndrome.National Organization for Rare Disorders.Toxic shock syndrome.Vostral S.Toxic shock syndrome, tampons and laboratory standard–setting.CMAJ. 2017;189(20):E726-E728. doi:10.1503/cmaj.161479US Food and Drug Administration.The facts on tampons—and how to use them safely.El Soufi H, El Soufi Y, Al-Nuaimi S, Bagheri F.Toxic shock syndrome associated with menstrual cup use.IDCases. 2021;25:e01171. doi:10.1016/j.idcr.2021.e01171Atchade E, De Tymowski C, Grall N, Tanaka S, Montravers P.Toxic shock syndrome: a literature review.Antibiotics (Basel). 2024;13(1):96. doi:10.3390/antibiotics13010096Poudel B, Zhang Q, Trongtorsak A, et al.An overlooked cause of septic shock: staphylococcal toxic shock syndrome secondary to an axillary abscess.IDCases. 2020;23:e01039. doi:10.1016/j.idcr.2020.e01039Center for Disease Control and Prevention.Clinical guidance for streptococcal toxic shock syndrome.Virginia Department of Health.Toxic shock syndrome. Epidemiology.Centers for Disease Control and Prevention.Toxic shock syndrome (other than streptococcal) (TSS) 2011 case definition.National Library of Medicine.Oritavancin injection.Additional ReadingGaensbauer JT, Birkholz M, Smit MA, Garcia R, Todd JK.Epidemiology and clinical relevance of toxic shock syndrome in US children.The Pediatric Infectious Disease Journal. 2018;37(12):1223-1226. doi:10.1097/inf.0000000000002002Sepsis Alliance.Toxic shock syndrome.

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Library of Medicine.Toxic shock syndrome.National Organization for Rare Disorders.Toxic shock syndrome.Vostral S.Toxic shock syndrome, tampons and laboratory standard–setting.CMAJ. 2017;189(20):E726-E728. doi:10.1503/cmaj.161479US Food and Drug Administration.The facts on tampons—and how to use them safely.El Soufi H, El Soufi Y, Al-Nuaimi S, Bagheri F.Toxic shock syndrome associated with menstrual cup use.IDCases. 2021;25:e01171. doi:10.1016/j.idcr.2021.e01171Atchade E, De Tymowski C, Grall N, Tanaka S, Montravers P.Toxic shock syndrome: a literature review.Antibiotics (Basel). 2024;13(1):96. doi:10.3390/antibiotics13010096Poudel B, Zhang Q, Trongtorsak A, et al.An overlooked cause of septic shock: staphylococcal toxic shock syndrome secondary to an axillary abscess.IDCases. 2020;23:e01039. doi:10.1016/j.idcr.2020.e01039Center for Disease Control and Prevention.Clinical guidance for streptococcal toxic shock syndrome.Virginia Department of Health.Toxic shock syndrome. Epidemiology.Centers for Disease Control and Prevention.Toxic shock syndrome (other than streptococcal) (TSS) 2011 case definition.National Library of Medicine.Oritavancin injection.Additional ReadingGaensbauer JT, Birkholz M, Smit MA, Garcia R, Todd JK.Epidemiology and clinical relevance of toxic shock syndrome in US children.The Pediatric Infectious Disease Journal. 2018;37(12):1223-1226. doi:10.1097/inf.0000000000002002Sepsis Alliance.Toxic shock syndrome.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Library of Medicine.Toxic shock syndrome.National Organization for Rare Disorders.Toxic shock syndrome.Vostral S.Toxic shock syndrome, tampons and laboratory standard–setting.CMAJ. 2017;189(20):E726-E728. doi:10.1503/cmaj.161479US Food and Drug Administration.The facts on tampons—and how to use them safely.El Soufi H, El Soufi Y, Al-Nuaimi S, Bagheri F.Toxic shock syndrome associated with menstrual cup use.IDCases. 2021;25:e01171. doi:10.1016/j.idcr.2021.e01171Atchade E, De Tymowski C, Grall N, Tanaka S, Montravers P.Toxic shock syndrome: a literature review.Antibiotics (Basel). 2024;13(1):96. doi:10.3390/antibiotics13010096Poudel B, Zhang Q, Trongtorsak A, et al.An overlooked cause of septic shock: staphylococcal toxic shock syndrome secondary to an axillary abscess.IDCases. 2020;23:e01039. doi:10.1016/j.idcr.2020.e01039Center for Disease Control and Prevention.Clinical guidance for streptococcal toxic shock syndrome.Virginia Department of Health.Toxic shock syndrome. Epidemiology.Centers for Disease Control and Prevention.Toxic shock syndrome (other than streptococcal) (TSS) 2011 case definition.National Library of Medicine.Oritavancin injection.

National Library of Medicine.Toxic shock syndrome.

National Organization for Rare Disorders.Toxic shock syndrome.

Vostral S.Toxic shock syndrome, tampons and laboratory standard–setting.CMAJ. 2017;189(20):E726-E728. doi:10.1503/cmaj.161479

US Food and Drug Administration.The facts on tampons—and how to use them safely.

El Soufi H, El Soufi Y, Al-Nuaimi S, Bagheri F.Toxic shock syndrome associated with menstrual cup use.IDCases. 2021;25:e01171. doi:10.1016/j.idcr.2021.e01171

Atchade E, De Tymowski C, Grall N, Tanaka S, Montravers P.Toxic shock syndrome: a literature review.Antibiotics (Basel). 2024;13(1):96. doi:10.3390/antibiotics13010096

Poudel B, Zhang Q, Trongtorsak A, et al.An overlooked cause of septic shock: staphylococcal toxic shock syndrome secondary to an axillary abscess.IDCases. 2020;23:e01039. doi:10.1016/j.idcr.2020.e01039

Center for Disease Control and Prevention.Clinical guidance for streptococcal toxic shock syndrome.

Virginia Department of Health.Toxic shock syndrome. Epidemiology.

Centers for Disease Control and Prevention.Toxic shock syndrome (other than streptococcal) (TSS) 2011 case definition.

National Library of Medicine.Oritavancin injection.

Gaensbauer JT, Birkholz M, Smit MA, Garcia R, Todd JK.Epidemiology and clinical relevance of toxic shock syndrome in US children.The Pediatric Infectious Disease Journal. 2018;37(12):1223-1226. doi:10.1097/inf.0000000000002002Sepsis Alliance.Toxic shock syndrome.

Gaensbauer JT, Birkholz M, Smit MA, Garcia R, Todd JK.Epidemiology and clinical relevance of toxic shock syndrome in US children.The Pediatric Infectious Disease Journal. 2018;37(12):1223-1226. doi:10.1097/inf.0000000000002002

Sepsis Alliance.Toxic shock syndrome.

Meet Our Medical Expert Board

Share Feedback

Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit

Was this page helpful?

Thanks for your feedback!

What is your feedback?OtherHelpfulReport an ErrorSubmit

What is your feedback?