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InfectiousICD-10: A48.3Approximately 0.8-3.4 per 100,000 people annually; menstrual TSS incidence has declined significantly

Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a rare but life-threatening condition caused by toxins produced by certain strains of Staphylococcus aureus or group A Streptococcus bacteria. TSS gained public attention in the 1980s due to its association with super-absorbent tampons, but it can affect anyone—men, women, and children—through wound infections, surgical sites, or other bacterial entry points. Prompt recognition and treatment are critical, as TSS can rapidly progress to organ failure and death.

Symptoms

Sudden high fever (102°F/38.9°C or above)
Low blood pressure (hypotension) causing dizziness or fainting
Sunburn-like rash, particularly on the palms and soles
Vomiting and diarrhea
Muscle aches and severe headache
Confusion or disorientation
Redness of the eyes, mouth, and throat
Peeling of the skin on the hands and feet (1-2 weeks after onset)

Causes

  • Toxins (TSST-1, exotoxin) produced by Staphylococcus aureus bacteria
  • Streptococcal pyrogenic exotoxins from group A Streptococcus
  • Prolonged tampon use, particularly super-absorbent types
  • Skin wounds, surgical incisions, or burns that become infected
  • Nasal packing after surgery

Risk Factors

  • Use of super-absorbent tampons or leaving a tampon in for extended periods
  • Recent surgery, wound, or burn
  • Viral infections such as influenza or chickenpox (for streptococcal TSS)
  • Use of contraceptive sponges or diaphragms
  • Young age (TSS is more common in people under 30)

Diagnosis

  • Clinical diagnosis based on CDC criteria (fever, rash, hypotension, involvement of 3+ organ systems)
  • Blood cultures and wound cultures to identify the causative organism
  • Complete blood count, comprehensive metabolic panel, and coagulation studies
  • Blood tests assessing organ function (liver, kidney, muscle enzymes)

Treatment

  • Immediate hospitalization and intensive care support
  • Intravenous antibiotics (clindamycin plus a beta-lactam antibiotic)
  • Aggressive intravenous fluid resuscitation for low blood pressure
  • Removal of the source of infection (tampon, wound packing, infected tissue)
  • Vasopressors if fluids alone cannot maintain blood pressure
  • Intravenous immunoglobulin (IVIG) in severe cases

Prevention

  • Change tampons every 4-8 hours and use the lowest absorbency needed
  • Alternate between tampons and pads during menstruation
  • Wash hands thoroughly before inserting tampons or handling wounds
  • Keep wounds clean and monitor for signs of infection
  • Seek prompt medical attention for infected wounds with systemic symptoms

When to See a Doctor

  • You develop sudden high fever, rash, and dizziness—especially during menstruation or after a wound infection
  • You have a wound or surgical site with signs of spreading infection and systemic illness
  • Any combination of fever, vomiting, diarrhea, and confusion develops rapidly

Frequently Asked Questions

Related Conditions

Cellulitis

Infectious

High Blood Pressure

Cardiovascular

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