Toxic shock syndrome

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a rare but very serious illness. It received much publicity in the 1980s when an outbreak occurred among US women who were using particular types of tampon during their periods (menstruation). However, nowadays only about half of all cases are linked to tampons. TSS can affect anyone, including postmenopausal women, men and children.

TSS can develop quickly and, if not treated urgently, can be life-threatening.

What causes toxic shock syndrome?

TSS is caused by a toxin (poison) produced by a common bacterium Staphylococcus aureus, often called 'golden staph'. These bacteria live on the skin and in areas such as the nose and vagina of many people, where they usually cause no harm. Only particular types (strains) of the staph bacteria produce the toxin that causes TSS.

When conditions are suitable these bacteria can multiply and produce the TSS toxin. This can happen in skin infections, wounds (e.g. burns and after operations) and in the vagina, particularly when a tampon or contraceptive sponge is present. Research suggests that tampon absorbency is a factor in TSS.

Some cases of TSS are caused by streptococcal bacteria, which are closely related to staphylococcal bacteria.

What are the symptoms of toxic shock syndrome?

TSS usually starts off as a sudden flu-like illness with a high temperature, aching muscles, vomiting and diarrhoea. The affected person may feel dizzy and may faint due to a fall in blood pressure. They may have a rash that looks like sunburn.

When should I see a doctor?

If you experience the symptoms of TSS, seek medical attention immediately. This is especially important if you are menstruating and using tampons, or have a skin infection or wound. If you are wearing a tampon, remove it immediately.

How is toxic shock syndrome treated?

TSS usually needs to be treated in hospital with antibiotics, which are often given intravenously (IV). You may also need 'supportive' treatment, including medicines to maintain your blood pressure and fluids to treat dehydration. As TSS can lead to kidney failure, you may need dialysis.

How can you prevent toxic shock syndrome?

When using tampons:

  • wash your hands before and after inserting a tampon;
  • change tampons regularly, preferably every 3-4 hours, and never leave a tampon in place for longer than 8 hours;
  • choose a tampon with the lowest absorbency possible for your period flow;
  • change to lower absorbency tampons as the flow reduces over the course of your period; and
  • consider using a sanitary pad or panty liner instead of a tampon whenever possible, especially at night.
Last Reviewed: 9 March 2011
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References

1. MayoClinic.com. Toxic shock syndrome (published 7 May 2009). http://www.mayoclinic.com/health/toxic-shock-syndrome/DS00221 (accessed Feb 2011).
2. Severe sepsis: staphylococcal toxic shock syndrome (revised Jun 2010). In: eTG complete online. Melbourne: Therapeutic Guidelines Ltd; Nov 2010. http://online.tg.org.au/complete/ (accessed Feb 2011).
3. Severe sepsis: Streptococcal sepsis including streptococcal toxic shock syndrome (revised Jun 2010). In: eTG complete online. Melbourne: Therapeutic Guidelines Ltd; Nov 2010. http://online.tg.org.au/complete/ (accessed Feb 2011).
4. Centers for Disease Control and Prevention (US). Toxic shock syndrome. Technical information (published 24 Oct 2005). http://www.cdc.gov/ncidod/dbmd/diseaseinfo/toxicshock_t.htm (accessed Feb 2011).
5. Family Planning NSW. The menstrual cycle fact sheet. http://www.fpnsw.org.au/fs004_menstrual_cycle.pdf (accessed Feb 2011).
6. NHS Choices (UK). Toxic shock syndrome (reviewed 12 Apr 2010). http://www.nhs.uk/Conditions/Toxic-shock-syndrome/Pages/Introduction.aspx (accessed Feb 2011).
Dr Michael Jones

Dr Michael Jones

Medical Editor, Your Doctor.