Understanding Toxic Shock Syndrome

Toxic shock syndrome is a rare but deadly disease that according to The National Organization for rare Disorders occurs in about 3 in 100,000 menstruating women. It is caused by certain types of bacterial toxins and is often associated with tampon use.

It occurs due to the release of toxins from the over-growth of bacteria called staphylococcus aureus, or staph. It can affect menstruating women using contraceptive sponges, diaphragms, or super-absorbent tampons. The body responds to a sharp decline in blood pressure, which leads to oxygen deficiency in organs and can lead to death. Men, women and children who have been exposed to staph bacteria, while recovering from surgery, open wounds or the use of prosthetic device can also experience toxic shock syndrome (Low, DE).

Symptoms: Following are the symptoms of toxic shock syndrome:

  • Fever.
  • Rash.
  • Low blood pressure.
  • Kidney problems/failure.
  • Respiratory problems/failure.
  • Malaise
  • Confusion.

These symptoms can rapidly progress to coma, stupor, and failure of multiple organs. The rashes can occur on the parts (mostly occur on exposed body parts) like lips, eyes, mouth, palms and feet soles.

Diagnosis: Diagnosis based on CDC criteria is as follows:

  • If body temperature is >38.9°C.
  • Systolic BP< 90 mmHg.
  • Desquamation.
  • The negative result of blood and throat.
  • Negative serology of Rickettsia infection, leptospirosis, and measles
  • Involving three or more organ system dysfunctioning:

✓ Gastrointestinal- vomiting, diarrhea.

✓ Muscular- myalgia.

✓ Mucous membrane hyperemia- vaginal, oral and conjunctival.

✓ Kidney failure.

✓ Low platelet count.

✓ Central nervous system problems like confusion.

✓ Liver inflammation.


What to do if you are experiencing symptoms?

If you are suffering from TSS consult a doctor immediately.

  • If you are facing symptoms like fever, rashes or extended female contraceptive usage seek medical assistance right away.
  • Immediately remove the tampon you are using unless you receive instructions from medical assistance.
  • Take symptom based treatments based on your condition recommended by a doctor such as the provision of oxygen, IV fluids, and kidney dialysis sometimes.
  • Keep it in mind that you are 30% more likely to get TSS if you have once suffered from it.
  • Do not use tampons and rely on pads only. Use substituent of contraception other than sponges and diaphragms.

Should You Use Tampons

The decision to use tampons is a personal one. Initially toxic shock syndrome was linked to the use of super absorbent tampons. Through research better tampons and usage guidelines have been established to keep women safe.  If you have not been diagnosed with TSS you can limit your risk by adhering to the following guidelines: Wash your hands before using a tampon, alternate tampon and pads usage, choosing pads with the lowest absorbency to manage menstrual flow, and using pads instead of tampons on light flow days. If you have been previously diagnosed with TSS, your defense against having it again as a menstruating female is to use pads instead of tampons. Follow the recommendations for using female contraceptives. Vaginally inserted devices, sponges and diaphragm must be used with care. ALWAYS consult your doctor to discuss risks and concerns regarding TSS


  • Low, DE (July 2013). "Toxic shock syndrome: major advances in pathogenesis, but not treatment". Critical Care Clinics. 29 (3): 651–75. 
  • Gottlieb, Michael; Long, Brit; Koyfman, Alex (June 2018). "The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature". The Journal of Emergency Medicine. 54 (6): 807–814.

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