About Toxic Shock Syndrome
Toxic shock syndrome (TSS) is a serious but uncommon infection caused by either Staphylococcus aureus (often called staph) and Streptococcus pyogenes (often called strep) bacteria, with most cases related to staph bacteria.
TSS was originally linked to the use of tampons because the earliest cases, in the late 1970s, were related to super-absorbent tampons. Research led to better tampons and better habits for using them, such as changing them often. The number of TSS cases dropped dramatically. Today about half of all TSS cases are linked to menstruation.
But TSS isn't strictly related to tampons. The contraceptive sponge and the diaphragm, two types of birth control methods, have been linked to TSS. It also can affect someone who has any type of staph infection, including pneumonia, an abscess, a skin or wound infection, the blood infection septicemia, or the bone infection osteomyelitis.
Most strep-related TSS cases are due to bacteria getting into areas of injured skin, such as cuts and scrapes, surgical wounds, and even chickenpox blisters.
Symptoms of TSS can include sudden high fever, a faint feeling, diarrhea, headache, a rash, and muscle aches. If your child has these symptoms, call your doctor right away.
Toxic shock syndrome starts suddenly, often with high fever (temperature at least 102ºF [38.8ºC]), a rapid drop in blood pressure (with lightheadedness or fainting), confusion, vomiting, diarrhea, headache, or muscle aches.
A sunburn-like rash may appear anywhere on the body, including the palms of the hands and the soles of the feet. A person also might have bloodshot eyes and an unusual redness under the eyelids or inside the mouth (and in the vagina in females). The area around an infected wound can become swollen, red, and tender, but might not even appear infected.
Other symptoms can include confusion or other mental changes, decreased urination, fatigue and weakness, and thirst.
If TSS is untreated, organs such as the liver and kidneys may begin to fail, and problems such as seizures, bleeding, and heart failure can develop.
The bacteria that cause toxic shock syndrome can be carried on unwashed hands so good hand washing is extremely important.
Girls can reduce their risk of TSS by either avoiding tampons or alternating them with sanitary napkins. Girls who use only tampons should choose ones with the lowest absorbency that will handle menstrual flow, and change the tampons often. On low-flow days, girls should use pads instead of tampons.
Between menstrual periods, store tampons away from heat and moisture (where bacteria can grow) — for example, in a bedroom rather than in a bathroom closet.
Because staphylococcus bacteria are often carried on hands, it's important for girls to wash their hands thoroughly before and after inserting a tampon. If your daughter has gotten her menstrual period, talk to her about taking these precautions. Any female who has recovered from TSS should not use tampons.
Clean and bandage all skin wounds as quickly as possible. Call your doctor immediately whenever a wound becomes red, swollen, or tender, or if a fever begins.
Diagnosis and Treatment
TSS is a medical emergency. If you think your child has TSS, call a doctor right away. Depending on the symptoms, a doctor may see you in the office or refer you to a hospital emergency department for immediate evaluation and testing.
If doctors suspect TSS, they will probably start intravenous (IV) fluids and antibiotics as soon as possible. They may take a sample from the suspected site of the infection, such as the skin, nose, or vagina, to check it for TSS. They also may take a blood sample. Other blood tests can help monitor how various organs like the kidneys are working and check for other diseases that might be causing the symptoms.
Medical staff will remove tampons, contraceptive devices, or wound packing; clean any wounds; and, if there is a pocket of infection (an abscess), a doctor may need to drain pus from the area.
People with TSS usually need to stay in the hospital, often in the intensive care unit (ICU), for several days so doctors can monitor their blood pressure and breathing and watch for signs of other problems, such as organ damage.
TSS is a very rare illness. Although it can be fatal, if recognized and treated promptly it is usually curable.
When to Call the Doctor
Call your doctor immediately if your child has any signs or symptoms of toxic shock syndrome. Once you realize that something is wrong, it's important to get medical attention right away. The sooner treatment begins, the better.
Reviewed by: Larissa Hirsch, MD
Date reviewed: June 2014