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Home :: Toxic Shock Syndrome

Toxic Shock Syndrome

An acute bacterial infection, toxic shock syndrome (TSS) is caused by toxin-producing, penicillin-resistant strains of Staphylococcus aureus, such as TSS toxin-1 and staphylococcal enterotoxins B and C. The disease primarily affects menstruating women under age 30 and is associated with continuous use of tampons during the menstrual period.

TSS incidence peaked in the mid­1980s and has since declined, probably because of the withdrawal of high­absorbency tampons from the market.


Although tampons are clearly implicated in TSS, their exact role is uncertain. Theoretically, tampons may contribute to development of TSS by:

  • introducing S. aureus into the vagina during insertion
  • absorbing toxin from the vagina
  • traumatizing the vaginal mucosa during insertion, thus leading to infection
  • providing a favorable environment for the growth of S. aureus

When TSS isn't related to menstruation, it seems to be linked to S. aureus infections, such as abscesses, osteomyelitis, and postsurgical infections.

Signs and symptoms

The signs and symptoms of toxic shock syndrome may include:

  • A sudden high fever.
  • Vomiting or diarrhea.
  • A rash resembling a sunburn, particularly on your palms and soles. After a week or so, the skin on your hands and feet generally begins to peel.
  • Confusion.
  • Muscle aches.
  • Sore throat
  • Red eyes
  • Sensitivity to light
  • Kidney failure
  • Seizures.
  • Headaches.


The diagnosis of toxic shock syndrome is based on several criteria: fever, low blood pressure (hypotension), rash that peels after 1-2 weeks, and at least 3 organs with signs of dysfunction. In some cases, blood cultures may be positive for growth of S. aureus .


If you think you may have toxic shock syndrome, stop using tampons immediately and go to the casualty department of your nearest hospital. Treatment for toxic shock syndrome includes:

  • Hospitalisation
  • Antibiotics to kill the infection
  • Intravenous fluids to boost blood pressure and treat dehydration
  • Administration of blood products
  • Dialysis (may be required in children who develop kidney failure)
  • Deep surgical cleaning of an infected wound

The following may help prevent TSS:

  • Menstruating girls and women should avoid using tampons if they have had TSS, as re-infection is common.
  • Prompt and thorough wound care is crucial in avoiding TSS.
  • Minimal usage of vaginal foreign body items such as diaphragms, tampons, or sponges helps to reduce the risk of TSS.

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