Toxic Shock Syndrome

HealthLinkBC File Number: 
Last Updated: 
January 2013

What is Toxic Shock Syndrome?

Toxic shock syndrome (TSS) is a rare, often life-threatening illness that develops suddenly after a bacterial infection. TSS can quickly affect several different organs including the liver, lungs and kidneys. Since TSS progresses quickly, medical help is needed as soon as possible.

What causes TSS?

TSS is caused by toxins made by some types of bacteria. The 2 bacteria that make toxins that can cause TSS are:

  • Staphylococcus aureus (SA)
  • group A Streptococcus (GAS)

For more information on GAS see HealthLinkBC File #106 Group A Streptococcal Infections.

Staphylococcus aureus are present in the nose or on the skin of up to 30 percent of people. They are also present in the vagina of about 10 to 20 percent of women. These bacteria are usually not harmful and only cause mild nose, throat or skin infections.

In some cases, SA infections can result in TSS. SA makes several toxins and when the toxins enter a person’s bloodstream they can have a severe reaction causing TSS. The toxins may enter the bloodstream through a wound to the skin, including a surgical wound. TSS can also occur in menstruating women using tampons. Most people, however, are not affected by the toxins because they have developed antibodies to them.

What are the symptoms of TSS?

Symptoms of TSS include flu-like symptoms such as fever, headache and muscle soreness, which develop quickly and are severe. Other symptoms may include: pain at the site of a wound, vomiting and diarrhea, signs of shock including low blood pressure and light-headedness, shortness of breath and sunburn-like rash.

In general, TSS symptoms can develop as soon as 12 hours after a surgical procedure. Symptoms usually develop in 3 to 5 days in women who are menstruating and using tampons.

What should I do if I think I have TSS?

Toxic shock syndrome requires immediate emergency care in a hospital. Call 9-1-1 or go to the nearest emergency department.

If you experience any of the symptoms of TSS while using a tampon, remove the tampon and see a doctor right away. Inform the doctor that you were using a tampon when the symptoms started.

What is the treatment for TSS?

TSS cannot be treated at home. Hospital care is required for treating SA infection and related complications caused by TSS, such as shock. Antibiotics will be given to kill the bacteria and stop further release of toxins.

If the source of infection involves a tampon, diaphragm or contraceptive sponge, it should be removed as soon as possible.

Who is at risk of TSS?

TSS from SA infection can affect anyone; however, some people are at greater risk of TSS than others.

Risk factors for TSS include:

  • Past history of SA toxic shock syndrome.
  • Prolonged use of a tampon, especially the super absorbent type.
  • Use of contraceptive sponges, diaphragms or intrauterine devices.
  • Irritation and inflammation of the vagina, also known as vaginitis.
  • A burn or skin injury, including a wound from surgery. Those who develop a SA wound infection after surgery may be at greater risk of TSS.
  • Recent respiratory infections, such as sinusitis, sore throat (pharyngitis), laryngitis, tonsillitis or pneumonia.

Although menstruating women using tampons are at higher risk of TSS, tampons do not cause TSS.

Can TSS be prevented?

TSS can be prevented by keeping all burns, wounds, scrapes and animal or insect bites clean.

Women who use tampons, diaphragms, or contraceptive sponges can prevent TSS by:

  • Following the directions on package inserts when using tampons, diaphragms or contraceptive sponges.
  • Washing your hands with soap before inserting or removing a tampon, diaphragm or contraceptive sponge.
  • Changing your tampon at least every 8 hours, or use tampons for only part of the day.
  • Wearing tampons and sanitary pads at alternate times. For example, use pads at night and tampons during the day.
  • Using tampons with the lowest absorbency that you need. The risk of TSS is higher with super absorbent tampons.
  • Not leaving your diaphragm or contraceptive sponge in for more than 12 to 18 hours.

Is it an emergency?

If you or someone in your care has chest pains, difficulty breathing, or severe bleeding, it could be a life-threatening emergency. Call 9-1-1 or the local emergency number immediately.
If you are concerned about a possible poisoning or exposure to a toxic substance, call Poison Control now at 1-800-567-8911.

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