Toxic shock syndrome (TSS) is a serious illness caused by bacteria. Toxic shock syndrome can cause severe damage and illness if the symptoms are not recognized and treatments started as soon as possible.

Risk factors for toxic shock syndrome

It’s most commonly caused by Staphylococcus (staph) or Streptococcus (strep) bacteria. The bacteria produce and release toxins into the bloodstream, which then spread to body organs.

“Toxic shock is rare, but those at highest risk are those who wear tampons,” said Cynthia Eckes, obstetrics and gynecology nurse practitioner with Marshfield Clinic Health System. “Risk is higher if using superabsorbent tampons, using tampons for many days of your cycle, or keeping a single tampon in place for more than 8 hours.”

Menstrual cups also carry a risk, although it is less than using tampons.

“It’s advised to empty them every four to six hours,” Eckes said. “The risk with menstrual cups is leaving them in too long, similar to tampons. They also need to be sterilized between each use.”

There are risks for toxic shock syndrome not associated with menstruation, too. Although rare, TSS may be a result of surgical or postpartum wound infections, cuts or burns, some lesions and respiratory infections.

Men, women and children are all at risk for TSS.

Toxic shock syndrome symptoms

TSS starts suddenly, often with high fever, dizziness, diarrhea, vomiting, headache, a rash or muscle aches.

Normally, the bacteria that cause TSS live on your skin or on your mucus membranes, like your throat or mouth, and don’t cause harm. Under certain conditions, some bacteria may grow rapidly and produce toxins.

“If you feel you are experiencing symptoms of TSS, I encourage you to seek care immediately,” said Eckes.

Tampon-associated toxic shock syndrome can be prevented

When using tampons:

• Change the tampon every four to eight hours.
• Do not leave the tampon in overnight.
• Use the lowest absorbency tampon you can.
• Consider using a pad at night or on low-flow days.

People who have had TSS can get it again. If you have had TSS, use tampons with caution and follow usage guidelines to help ensure safe use.

Toxic shock syndrome treatments

Standard treatment for toxic shock syndrome includes antibiotics through an IV. Antibiotics can help control bacteria growth and limit toxin production.

Treatments also may include:

• Oxygen to help with breathing.
• Fluids to prevent dehydration and increase blood pressure.
• Medicine to help increase blood pressure.

“Prompt treatment with antibiotics and intravenous fluids is imperative,” Eckes said.

For toxic shock syndrome help, talk to a Marshfield Clinic Health System provider.

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