Toxic Shock Syndrome

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is an uncommon but serious, life-threatening complication of certain types of infections. It is caused by either staph (Staphylococcus aureus) bacteria or strep (Streptococcus pyogenes) bacteria. The bacteria produce toxins that can quickly lead to organ failure and even death.

Toxic shock syndrome was originally linked to the use of super-absorbent tampons. But changes in tampons and usage habits have made it less common. Today about half of toxic shock syndrome cases are caused by tampon use. Many cases are the result of bacteria getting into areas of injured skin. These include cuts and scrapes, surgical wounds, or chickenpox blisters. Toxic shock syndrome affects men, women, and children.

What are the symptoms of toxic shock syndrome?

You are at higher risk for developing toxic shock syndrome if you have:

• Recently given birth
• A staph infection
• Been on your menstrual period
• Had recent surgery
• A wound infection
• Foreign bodies or packings (such as those used to stop nosebleeds) inside the body

A sudden fever of 102°F or higher is a warning sign for anyone who is at risk for toxic shock syndrome. Other symptoms might include:

• Headache
• Vomiting
• Low blood pressure
• Confusion
• Diarrhea
• Muscle aches
• Red rash on the palms of your hands or bottom of your feet

If you or your child has symptoms of toxic shock syndrome, go to the emergency room right away. The infection can get worse quickly. It can cause organs such as the liver or kidneys to fail. It can also cause seizures, bleeding, and heart failure. If left untreated, it can lead to death.

What causes toxic shock syndrome?

Most cases of toxic shock syndrome are caused by a toxin that is produced by staph bacteria. Some cases are caused by a toxin from strep bacteria. Not all staph or strep infections lead to toxic shock syndrome.

Toxic shock syndrome gained national attention in the late 1970s. It was tied to tampon use during a woman’s menstrual period. Newer research shows using a tampon for longer than the recommended time without changing it can create the perfect environment for a staph infection. But the use of a tampon is not the only way. The same danger exists with certain birth control devices when they are used longer than the recommended time. These could include a diaphragm, sponge, or cervical cap.

With tampon use, many researchers believe that inserting a tampon can scratch the vagina. This makes it vulnerable to an infection. They also think tampons made with artificial fibers are more likely to trap bacteria than tampons made with 100% cotton.

Toxic shock syndrome can also occur for other reasons. It can occur when a wound from a burn or surgery doesn’t heal properly. It can also happen from a skin infection, just after childbirth, and even in the case of a serious nosebleed that requires the use of packed medical gauze to stop it.

How is toxic shock syndrome diagnosed?

There is no rapid test for toxic shock syndrome. Doctors can test for staph bacteria using a blood sample or a sample taken from an infected wound. However, relying on that alone takes too long when your body is in distress. Doctors usually diagnose toxic shock syndrome based on symptoms such as a high fever, low blood pressure, and a rash.

Toxic shock syndrome can affect multiple organs. Your doctor may order other tests to see how far the illness has spread. These could include a CT scan, chest X-ray, or lumbar puncture.

Can toxic shock syndrome be prevented or avoided?

The best way to avoid toxic shock syndrome is to prevent infections. Good hand-washing is always a good defense. If you have an open wound or burn, be sure it is properly cleaned. Watch for signs of infection, such as redness, swelling, or pus. Ask your doctor how you should take care of the wound or burn to avoid getting a staph infection.

You can reduce your risk of toxic shock syndrome by using tampons carefully. Doctors suggest that you should do the following during your period:

• Alternate between tampons and pads so you don’t create an environment for the bacteria to grow.
• Avoid using high-absorbency tampons.
• Change your tampon frequently, as recommended on the package (usually every 4 to 8 hours).
• On the lighter days of your period, use pads instead of tampons.
• Wash your hands before and after inserting a tampon.

You can get toxic shock syndrome more than once. If you’ve had it before or you’ve had a serious staph or strep infection, don’t use tampons.

Toxic shock syndrome treatment

Toxic shock syndrome is a medical emergency. Call your doctor right away if you are having symptoms. You’ll probably need to go to the hospital. Once there, the medical staff may start an IV to give you fluids, antibiotics, and blood pressure medicine. If your kidneys are failing, you also may be given blood plasma and kidney dialysis. If you are a woman who has a tampon, diaphragm, sponge, or cervical cap in place, it will be removed. If your infection is due to an infected wound, the wound will be cleaned thoroughly. Once you are stable, you may be moved to the intensive care unit for monitoring.

Living with toxic shock syndrome

Toxic shock syndrome can lead to death in up to 50% of cases. There may be significant challenges if you survive the initial infection. This may include recovering from organ failure or from being on life support.

Questions to ask your doctor

• Could there be something other than toxic shock syndrome causing my symptoms?
• What kinds of tests will I need?
• How long is too long to wear a tampon or certain birth control devices?
• Are there any health conditions that increase my risk of getting a bacterial infection that leads to toxic shock syndrome in a wound?