Toxic shock syndrome (TSS)

The symptoms of TSS usually start suddenly and quickly get worse, especially if treatment isn't started as soon as possible. 

Get medical help straight away if you have the symptoms below, because TSS can quickly result in the failure of important body organs, such as your kidneys, lungs and heart. The more of these symptoms you have, the sooner you should seek help.
 

Toxic shock syndrome is a medical emergency.

If you're using  a tampon, remove it straight away. Also tell your doctor if you've been using a tampon, recently had a burn or skin injury, or if you have a skin infection such as a boil.

Toxic shock syndrome (TSS) happens when bacteria called Staphylococcus aureus (often called Staph) or Streptoccocus pyogenes (often called strep) release harmful toxins (poisons) into your bloodstream.

These bacteria usually live harmlessly on your skin or inside your nose. However, if they get into your bloodstream through damaged skin, such as cuts and scrapes, surgical wounds and even chickenpox blisters, they can cause severe and life-threatening infections (eg, sepsis and toxic shock syndrome). 

TSS isn't spread from person to person and you don't develop immunity to it once you've had it, so you can get it more than once.

Anyone at any age can get TSS. 

It used to be more common in people using tampons for their periods – especially if they used highly absorbent tampons and didn’t change them often enough as this could encourage growth of bacteria. Changes to the production of tampons lead to a fall in the number of cases of TSS related to tampon use. However, tampons can also cause tiny cuts in your vagina where bacteria can get into your bloodstream and cause TSS.

It’s now more common for TSS to be related to complications of other infections.

Other risk factors include:

• the use of contraceptive devices such as a diaphragm or contraceptive sponges
• recent childbirth, miscarriage or abortion
• infected cuts, wounds, boils or burns
• wound packing or infection after surgery
• nasal packing to stop nosebleeds
• recent staphylococcal or streptococcal infections such as sore throat, cellulitis, pneumonia, osteomyelitis, sinusitis or skin wounds
• the use of menstrual cups and female barrier contraceptives
• previous TSS (you're more likely to get TSS if you've had it before).

The diagnosis of toxic shock syndrome (TSS) is based on whether you have particular symptoms and signs. These include fever, a widespread flat red rash, low blood pressure, vomiting or diarrhoea and severe muscle pain.  Read more about TSS symptoms above. You may also have peeling skin on your hands and feet but this usually happens 1 to 2 weeks after the rash started.

Tests to diagnosis TSS include:

• swabs from the infection site – to test for the bacteria causing the infection
• blood and urine tests – to test for kidney, liver, muscle and bleeding problems.

As TSS can affect different body organs, your doctor may also order other tests such as a chest X-ray, CT scan or lumbar puncture.

TSS gets worse very quickly and can be fatal if it's not treated quickly. If it's diagnosed and treated early, most people make a full recovery. If you have TSS, you'll need to be admitted to the hospital for treatment.

Treatment can include:

• removal of infection sources such as tampons, nasal pack or contraceptive diaphragm
• draining and cleaning your wound site
• antibiotics to treat the infection
• intravenous fluids (given through a drip)
• medicines to help control your blood pressures
• oxygen and any other necessary support depending on your condition.

If toxic shock syndrome isn’t treated quickly you may develop complications such as heart and lung problems, kidney failure and blood clotting problems. About 5 to 15% of people who get toxic shock syndrome (TSS) die. TSS caused by Streptococcus pyogenes is more likely to be fatal.

You’re more likely to get TSS again if you’ve had it before. 

Toxic shock syndrome (TSS) is very rare, but you should do the following things to reduce your chances of catching or spreading a bacterial infection that may cause TSS.

In general

• Wash your hands regularly.
• Take good care of any wounds you get, including cuts and burns.
• Use good hygiene practices when inserting anything in your vagina.
• See a healthcare provider if you notice signs of infection such as redness, swelling or pain around a wound.
• Don't use tampons, menstrual cups, contraceptive caps or diaphragms if you've had TSS before.

If you're using tampons

Maintaining good personal hygiene when you have your periods can reduce your risk of TSS. 

• Wash your hands thoroughly before and after you change your tampon.
• Only use 1 tampon at a time.
• Use a tampon with the lowest absorbency you need – don't use super-absorbent tampons.
• Change your tampon regularly (see the directions on the pack – usually every 4 to 8 hours).
• Take your tampon out before you go to sleep.
• Don't force your tampon in as it can cause small cuts in your vagina.
• Use the tampon as soon as you unwrap it – having it unwrapped for too long can increase the chances of it coming into contact with bacteria.
• Alternate between tampons, pads or panty liners during your period, eg, use pads instead of tampons overnight.
• Remember to remove your last tampon after your period has finished.
• Don't use tampons if you've had TSS before.