Illistration of bacteria that causes toxic shock syndrome
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What is Toxic Shock Syndrome?

You might have heard of toxic shock syndrome, particularly if you use tampons. But what you may not know is what causes it, or the symptoms to look out for. Let’s take a look at everything you need to know about this rare, but serious, bacterial condition. Read on to find out more about toxic shock syndrome…

What causes toxic shock syndrome?

Toxic shock syndrome (TSS) happens when you’re infected with bacteria that release harmful toxins into your body. It’s most commonly caused by the bacteria Staphylococcus aureus and Streptococcus pyogenes, and can also be caused by another bacteria called Clostridium sordellii.

These bacteria live on our skin, under our armpits, in the vagina, and in our mouths and noses, and when they stay at surface level, they don’t cause us any harm. However, they sometimes work their way deeper into the body through the bloodstream - and this is when they can release toxins that are potentially life-threatening.

Toxic shock syndrome gained a lot of publicity in the late 1970s and early 1980s after the deaths of several young women. It turned out that these women were all menstruating and had been using super-absorbent tampons when they died.

Toxic shock syndrome from tampons is caused by a specific strain of the Staphylococcus aureus bacteria. Although toxic shock syndrome with tampons is the most well-known way of contracting the condition, it’s important to note that it’s not caused by tampons directly. You can still get toxic shock syndrome when using pads or menstrual cups - and toxic shock syndrome doesn’t only affect menstruating women. In fact, anyone can get toxic shock syndrome. 

Some of the other toxic shock syndrome causes include:

  • Cuts, burns, boils, or insect bites on your skin
  • Post-surgery wounds
  • Childbirth
  • Staphylococcal or streptococcal infections, like a throat infection, cellulitis, or impetigo

Toxic shock syndrome symptoms

So, what are the symptoms of TSS to look out for? They vary from person to person but the most common symptoms include:

  • A high temperature
  • General flu-like symptoms, including a headache, body aches, sore throat, cough and feeling cold
  • Feeling sick or vomiting
  • Diarrhea
  • Aching muscles
  • A sunburn-like rash, that may peel and flake
  • Dizziness or feeling faint
  • Respiratory distress and difficulty breathing
  • Confusion, listlessness and tiredness
  • Your lips, tongue and whites of your eyes turning bright red
  • A fever (over 102°F) that spikes suddenly 
  • Low blood pressure
  • Shedding of the skin in large sheets, especially over the palms of the hands and soles of the feet

Seek medical attention immediately if you are experiencing any of the symptoms of toxic shock syndrome. You can also talk to your healthcare professional if you have any questions about this condition as toxic shock syndrome affects each person differently.

How soon do toxic shock syndrome symptoms appear?

TSS can come on quickly. If you develop toxic shock syndrome after surgery, it can develop as soon as 12 hours. Otherwise, it may take between 24 and 48 hours for symptoms to appear. The first signs are usually flu-like symptoms, including a chill or fever, muscle aches and vomiting, followed by low blood pressure. From there, symptoms can quickly become far more serious, including signs of organ failure.

Treatment for toxic shock syndrome

If you’re experiencing the symptoms of toxic shock syndrome, it’s important that you seek medical attention as soon as possible. Call 911 or go to your nearest emergency room straight away. If you’re using a tampon, you should remove it and let your healthcare provider know that you’ve been using tampons and, if possible, what brand and absorbency. 

Depending on the severity of the condition, you might receive treatment in a number of different ways, including:

  • Antibiotics
  • Oxygen to help you breathe
  • Fluids to prevent dehydration and organ damage
  • Dialysis if your kidneys stop functioning
  • Surgery
  • Blood pressure medicine 

Most people will start to feel better within a couple of days, but you may be required to stay in hospital for a few days or even weeks. The majority of people make a full recovery, given they have swift medical intervention and appropriate medical care.

How common is toxic shock syndrome?

Toxic shock syndrome can be potentially life-threatening, but there’s no need to be overly concerned about it, as it’s a fairly rare condition. In the USA, it’s estimated that 3-6 per 100,000 people are affected by the condition every year, and it’s thought that TSS related to the use of tampons affects roughly 1 in 100,000 menstruating women. 

How to prevent toxic shock syndrome

There are some things you can do to reduce the risk of contracting TSS.

Toxic shock syndrome from tampons

If you prefer to use tampons when you’re on your period, one of the most important things you can do is to always use a tampon with the lowest absorbency suitable. That means if you have a fairly light flow, you should use a light absorbency tampon rather than one designed for heavy periods. You might need to switch the type of tampon you use throughout your period, for example using a heavier absorbency at the start of your period and swapping to a lighter tampon or using pads towards the end.

You should also always wash your hands before and after inserting a tampon, and never leave a tampon in for longer than directed. Always follow the instructions on the pack, but it’s usually recommended that you change it at least every four to eight hours. Insert a fresh tampon before going to bed, and remove your tampon as soon as you wake up. You can also consider using pads overnight instead if you want to sleep longer or don’t want the hassle of changing tampons in the night.

In general, it’s a good idea to alternate between tampons and pads during your period, and you should never use more than one tampon at a time. If you have a heavy flow, you could instead double up with tampons and pads or try period underwear or a menstrual cup.

Toxic shock syndrome from wound care

Remember that toxic shock syndrome isn’t only associated with tampon use. It can also be caused by infected wounds, so you should always seek medical advice if you notice any signs of infection around a wound or burn - look out for things like swelling, redness and pain. Keep wounds clean and dry to avoid infection and talk to a healthcare professional if you need advice on caring for a wound.

Toxic shock syndrome from contraception

Toxic shock syndrome has been linked to some methods of contraception such as the diaphragm, cap, and the birth control sponge. Always follow instructions when using these methods. TSS is also an extremely rare side effect of intrauterine devices (IUDs). 

For those who’ve had toxic shock syndrome in the past, it’s recommended that you avoid using tampons and female barrier birth control entirely. Check out some other birth control options and learn about some alternative contraceptives out there!

Get to know your body better with Natural Cycles

Thanks for reading up on toxic shock syndrome. We know this can be a daunting topic and although it’s rare, TSS can be a serious condition, so it’s important to know what to look out for.

At Natural Cycles we’re passionate about increasing knowledge when it comes to female health. We’ve created the world’s first FDA cleared birth control app. Using the science of your cycle, it works out your fertile days so you can either abstain from sex or use protection when you’re fertile. By learning the pattern of your cycle you can also get to know what’s normal for you, so it’s easier to spot any symptoms or changes happening in your body.

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Written By

Lauren McKay

Lauren is an Edinburgh-based writer, yoga teacher, and advocate for driving women's health knowledge. When she's not at her laptop you'll find her in the yoga studio, running up a hill, or exploring Scotland's beautiful scenery.

Jack in a suit and tie holding a microphone and giving a presentation.

Scientifically Reviewed

Jack Pearson

Dr. Jack Pearson is Natural Cycles’ in-house medical expert. With 10+ years of experience working in the field of fertility, he dedicates the majority of his time to conducting groundbreaking research within the field of women's health.

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