Toxic Shock Syndrome


Warning: If you show signs of toxic shock syndrome including fever, vomiting, low blood pressure, or a sunburn-like rash, particularly during menstruation and tampon use or if you have had a recent surgery, we advise you to seek immediate medical attention.


Toxic shock syndrome is a potentially fatal condition which can occur quickly due to the growth of the bacteria Staphylococcus aureus, known as staph.5 The condition can also be caused by group A streptococcus, or strep, bacteria. Toxic shock syndrome is most commonly associated with the use of superabsorbent tampons, but certain types have been pulled off the market making the condition less common for menstruating women. Although it is less widely known, toxic shock syndrome can affect children, men, and postmenopausal women.2 Toxic shock syndrome is a serious condition but it is not a Sexually Transmitted Infection.

Signs and Symptoms

If you have a high fever or are vomiting while you are menstruating time seek medical help immediately, especially if you are using tampons. If you are experiencing any of these symptoms, remove the tampon, contraceptive sponge, diaphragm, or cervical cap immediately.5 It is common for a “sunburn-like” rash to be present within a few hours of toxic shock syndrome and this rash can lead to the skin peeling. This rash occurs most commonly on the palms of the hands and soles of the feet.3

There are several common signs of toxic shock syndrome. The symptoms that may occur if you have toxic shock syndrome include the following.

  • A sudden high fever
  • Low blood pressure (hypotension)
  • Vomiting or diarrhea
  • A rash resembling a sunburn, particularly on your palms and soles
  • Feeling Lightheaded or Confused
  • Muscle aches
  • Redness of your eyes, mouth, and throat
  • Seizures
  • Headaches

If you are experiencing any of these symptoms, seek medical attention immediately.3

Causes of Toxic Shock Syndrome

It has been noted that prolonged use of tampons with staphylococcus aureus (staph) present can increase the production of the toxin, which can get through small cuts in the vaginal lining or through the uterus into the bloodstream.3 A tampon completely soaked in blood can grow bacteria rapidly. It is more likely that a tampon made of polyester foam will grow bacteria than those made of cotton or rayon fibers because the polyester foam is a more ideal environment for the bacteria to thrive in. Using a tampon can cause microscopic tears, which can rupture blood vessels. Tears are also likely to occur when a superabsorbent tampons is used during a light menstrual flow or if it is left in the vagina for too long. Although toxic shock syndrome is most common in women using superabsorbent tampons, it can also occur in women using menstrual sponges, diaphragms, and cervical caps and it is more common for women who have just given birth.5 It is also more common for people who have had surgery recently, have cuts or burns, or people who have had a viral infection such as the flu or chickenpox.2 The staph bacteria can cause toxic shock syndrome as it releases toxins into the bloodstream, which can damage organs and body tissues and can lead to death.4 Staph bacteria can cause skin infections for men and women who have been exposed after a surgery or burn occurs.5

Diagnosis & Treatment

There is no rapid test for toxic shock syndrome.1 Diagnosing toxic shock syndrome is based on the Centers for Disease Control clinical and laboratory: A person can be diagnosed with this syndrome if they have three or more symptoms—one of which is feeling skin—or, a person can be diagnosed with this syndrome if they have five or more symptoms—none of which is peeling skin. Treatment includes intravenous fluid and electrolyte replacement, vaginal examination to remove a tampon or contraceptive device if one is present, and a culture to check for staph.3 If you are showing signs of kidney failure, you may be given blood plasma and kidney dialysis. If you have a wound that is open, it will be thoroughly cleaned.1 Researchers have ruled out many causes of toxic shock syndrome including feminine deodorant sprays, and douching, and contaminants on underwear and other clothing. It is also impossible to get toxic shock syndrome from drug or alcohol use, cigarette smoking, swimming or bathing, sexual activity, and any specific medical history.5


Tampon users should make themselves aware of the symptoms of toxic shock syndrome and should seek medical attention if symptoms occur.3 It is recommended that women alternate between tampons and pads to ensure that they are not creating an environment for staph to grow.1 Tampon users should also try to use the lowest absorbency tampon possible and should change out tampons at least every four to eight hours. If you have had toxic shock syndrome or have had a serious staph or strep infection, it is not recommended that you use tampons.2 Women who use vaginal contraception devices should follow instructions and talk to physicians about concerns or questions to minimize risk.3 Men and women who have an open wound or burn should make sure it is properly sanitized and should check for signs of infections such as redness, swelling, or pus to avoid a staph infection.

Additional Facts About Toxic Shock Syndrome

Toxic shock syndrome leads to death in 50% of reported cases.1 Toxic shock syndrome can occur in people of all ages, although about half of the cases occur in women of menstruating age.2 Up to 30% of women who have toxic shock syndrome at some point in their lives will have the condition again, and over one-third of toxic shock syndrome occurs in women under the age of 19. Toxic shock syndrome may cause death due to the body’s response to the staph bacteria commonly leading to hypotensive shock which stops the heart and lungs from working.5 Toxic shock syndrome can occur when sponges, diaphragms, and cervical caps are left in the vagina for more than 30 hours, or if small pieces of the sponge are left behind after removal.5 The Food and Drug Administration now requires companies who manufacture tampons to print guidelines on boxes and requires that they use standard absorbency measures and labeling.2


  1. “Toxic Shock Syndrome.”, 1 Jan. 2017.
  2. “Toxic shock syndrome.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 May 2017.
  3. “Toxic Shock Syndrome.” NORD (National Organization for Rare Disorders).
  4. “Toxic shock syndrome.” Toxic shock syndrome | healthdirect.
  5. “Understanding Toxic Shock Syndrome — the Basics.” WebMD, WebMD.

Last updated: 29 January 2018.