Toxic Shock Syndrome: Tampons and More
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Toxic shock syndrome (TSS) usually strikes women. While it can be extremely serious, it is also quite rare. Often associated with tampon use, TSS is caused by a toxin released by specific bacteria. Although TSS can affect anyone, most cases occur in teenage girls and menstruating women. Some cases have been related to exposure to an infection contracted during surgery or after suffering a burn or open wound. Although most people have naturally occurring antibodies that protect them from this toxin, some do not, and it is in these people that infection can lead to TSS.

The Tampon-TSS Connection
In the late 1970s, tampons—especially the super-absorbent type—were linked to an increased susceptibility to TSS, especially in women under age 25. Although the exact relationship between tampon use and TSS is still not known, it is believed that tampons may cause very small cuts, lacerations, or ulcerations in the vaginal wall, which make it easier for bacteria to enter into the bloodstream.

Symptoms Occur Suddenly
The symptoms of TSS, which almost always come on very suddenly and occur in women, usually strike during or following a menstrual period. These symptoms include:

  • High fever (102°F [39°C] or higher)
  • Chills
  • Diarrhea and/or vomiting
  • Rash resembling a sunburn that eventually peels skin on the palms and soles
  • Lightheadedness or fainting caused by a drop in blood pressure
  • Rapid pulse
  • Headache
  • Muscular aches and pains
  • Confusion
  • Abdominal pain
  • Blood-shot eyes
  • Agitation
  • Sleepiness
  • Vaginal discharge (may be watery or bloody)
  • Swelling in the face and eyelids
  • Extreme fatigue and/or weakness
While relatively rare, TSS can lead to serious complications, especially if left untreated. TSS can lead to shock , kidney and/or liver failure, paralysis, and miscarriage . In a very small number of cases, death can result from hypotensive shock. The body's reaction to the toxins can be overwhelming—blood pools near the digestive tract, causing the heart and lungs to be deprived of blood and to stop working.

Urgency: Treating TSS Immediately
If you suddenly have a high fever or any other symptoms around the time of your menstrual period, call your doctor. If a you are using a tampon, remove it right away. TSS can be a medical emergency, so it is important to seek medical attention immediately.

If TSS is suspected, treatment will be started as soon as possible. Once treatment is underway, your doctor can perform tests to confirm a diagnosis. This is necessary because many of the symptoms associated with TSS are similar to several health conditions or diseases. TSS can be confimed with a vaginal culture.

Treatment can include:

  • Large amounts of fluids (intravenously if necessary) to keep hydrated and control the effects of the fever
  • Antibiotics to help control the infection
  • Medications to control and reduce the fever, as well as aches and pain
In severe cases, a hospitalization may be required to allow the doctor to more closely monitor and, if necessary, treat for the possible complications that might develop. Complications of TSS include septic shock , kidney failure , or liver failure.

Prevention: The Best Bet
Like most medical conditions, the best treatment for TSS is prevention. To that end, all women should take the following preventative measures:

  • Wash your hands before inserting a tampon.
  • Use tampons with as low a degree of absorbency as is practical, and don't use super-absorbent tampons unless instructed to do so by your doctor.
  • Change your tampon every 4-8 hours.
  • Do not leave a tampon in overnight.
  • When practical, use a pad instead of a tampon.
Finally, though TSS is not contagious, it can strike the same person more than once. If you've had TSS before, don't use tampons again without first getting approval from your doctor.

The American College of Obstetrics and Gynecology

United States Food and Drug Administration


Women's Health Matters

Toxic shock syndrome. EBSCO DynaMed website. Available at: Updated May 4, 2010. Accessed September 27, 2013.

Toxic shock syndrome. Nemour's Kids Health website. Available at: Updated January 2011. Accessed September 27, 2013.

Toxic shock syndrome. Virginia Department of Health. Available at: Published August 2013. Accessed September 27, 2013.

Last Reviewed September 2013

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