Toxic Shock Syndrome

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What is Toxic Shock Syndrome? Toxic shock syndrome (TSS) is a rare and life-threatening medical health condition. In TSS, certain bacteria (Staphylococcus. aureus, or group A Streptococcus) grow and spread excessively, leading to the immune system’s fight against these bacteria from all corners of the body. Read More

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Toxic Shock Syndrome

What is Toxic Shock Syndrome?

Toxic shock syndrome (TSS) is a rare and life-threatening medical health condition. In TSS, certain bacteria (Staphylococcus. aureus, or group A Streptococcus) grow and spread excessively, leading to the immune system’s fight against these bacteria from all corners of the body. The attack from bacteria in all body parts brings about the “toxic shock” (basically meaning shock from toxins). TSS was first described in children in 1978 [1]. Although it can affect anyone, including men, women, and children of all ages, toxic shock syndrome mainly affects women who use tampons for a relatively longer duration. It also affects women who use tampons more frequently. It also affects women who use devices such as menstrual cups, diaphragms, and contraceptive sponges [2]. Toxic shock can last between a week and a couple of months if treated effectively. 
Toxic shock syndrome
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Complications and Side Effects of Toxic Shock Syndrome

If left untreated for 7─10 days after its sudden appearance, bacteria-caused acute-onset toxic shock syndrome (TSS) can result in:
  • Heart issues.
  • Renal failure.
  • Cardiac arrest.
  • Acute seizures.
  • Liver problems.
  • Bladder problems.
  • Kidney dysfunction.
  • Restricted blood flow.
  • Coagulation disorders.
  • Infections of the spine.
  • Emotional changes and memory loss.
  • ARDS (adult respiratory distress syndrome).
  • Low platelet and red blood cells (RBCs) count.
  • Uncontrolled bleeding (in menopausal women).
  • Traumatic shock sometimes leads to death.

Toxic Shock Syndrome Risk Factors

Certain risk factors may lead to sudden toxic shock syndrome in the immune system. A few of the risk factors are: 
  • A History of wounds from surgery.
  • Use a contraceptive sponge.
  • Have a deep skin health condition.
  • Have had an abortion.
  • Undergoing menopause.
  • A young or middle-aged woman.
  • Recently had burns on the skin.
  • Use a tampon that highly absorbs fluid.
  • History of skin infection.
  • History of viral infections, such as chickenpox or flu.

Toxic Shock Syndrome Diagnosis

You can easily notice if you have toxic shock syndrome or not, just by physical appearance. However, to be entirely sure, the doctor may require the following tests to confirm the existence of TSS: Blood samples, via:
  • Complete blood count (CBC) test.
  • Platelet count.
  • Prolonged prothrombin and activated partial thromboplastin times are performed to evaluate blood clotting ability [3].
  • Blood culture to know the cause of TSS.
  • Lumbar puncture
Urine samples via urinalysis. Swabs from :
  • Cervix.
  • Vagina.
  • Throat.
X-ray scans, such as:

Toxic Shock Syndrome Treatment

The specialists in charge of treating toxic shock syndrome include:
  • Obstetricians.
Pregnant and lactating mothers can be affected by TSS.
  • Gynecologists and Urologists.
Menstruating females are prime targets of TSS. However, men can also be affected, though not often.
  • Pediatricians.
Children can also be affected by TSS, although this does not happen often.
  • Surgeons.
Surgery helps to drain pus or blood from past surgical wounds. TSS is considered to be a medical emergency. Therefore, the patient has to be treated aggressively, find the cause of the disease, and be treated in the intensive care unit with appropriate and prompt care.  Treatments for toxic shock syndrome vary and may include:
  • Intravenous (IV) drip.
This helps treat fever and other flu-like symptoms associated with TSS and provide sufficient hydration.
  • Blood bank deposits.
These are used in supplying blood to the heart, thereby reducing the restriction of blood flow.
  • Kidney dialysis.
The clinical purification of blood by dialysis can be used to substitute for the kidney’s normal function in patients with kidney problems.
  • Gamma globulin injections.
This help treats symptoms associated with inflammation and failure of the body organs and boosts the immune system.
  • Surgery.
Although not necessarily needed in treating TSS, a surgical operation may be helpful when you have an untreated wound from previous surgery. Surgical wounds contribute to the opening of spores that give the free entrance of bacteria into the body, thereby weakening the immune system. Therefore, surgical debridement is the best option.
  • Hyperbaric oxygen is used in a few patients to treat skin wounds.
  • Antibiotics.
The type of antibiotic you take to cure TSS depends on the bacteria causing the syndrome. These medications can come in the form of heart medication (to eliminate hypotension) and vitamins or supplements (to improve kidney functions).  The antibiotics used in treating TSS include:
  • Vancomycin.
  • Beta-lactam.
  • Lincosamides.
  • Aqueous penicillin G.
  • Tetracyclines.
  • Nafcillin.
  • Oxacillin.
  • The addition of clindamycin and gentamycin reduces toxin production.

Toxic Shock Syndrome Prevention

You can prevent toxic shock syndrome via:
  • Clean hygiene.
Maintain clean hygiene by washing your hands regularly to eliminate the chances of getting infected by bacteria.
  • Tampons.
In toxic shock syndrome, tampons play a massive role in transferring staph and strep bacteria from the external layer of the skin into the immune system. As a result of this, menstruating females should be careful when using these materials.
  • Change your tampon every 5 hours and unwrap it only when you want to use it immediately.
  • Do not use highly absorbing tampons.
  • Do not take turns switching it with any other menstrual material.
  • Consider using sanitary pads and menstrual cups instead.
Menstrual cups collect blood rather than absorb it. Hence, it is safer to use than tampons. Whereas the safety of sanitary pads is not as high as the safety of menstrual cups, they are better to use than tampons.

Toxic Shock Syndrome Prognosis

The survival rate of untreated toxic shock syndrome is low (about 30% or less). Generally, the mortality rate of TSS varies between 20% and 70%. Dying from staphylococci-caused TSS is estimated to have a 5%─15% chance, while dying from streptococci-cause TSS can go as high as having a chance of 70%. If treated early and adequately, patients of TSS can undergo full recovery with a minimum 99% success rate. But if not, death can ensue. 
symptoms of toxic shock syndrome
Picture Courtesy: UPSC


The signs and symptoms of toxic shock syndrome are many. The bacteria-caused toxic shock syndrome signs often come all at once, eventually disappearing after treatment. 

These indications and signs of toxic shock syndrome include:

  • Weakness.
  • Headaches.
  • Sudden seizures.
  • Unexplainable confusion.
  • Vomiting, nausea, or diarrhea.
  • Muscle dystrophy and aching.
  • Sudden rise in body temperature.
  • Redness of the eyes, tongue, lips, and throat.
  • Steep lowering in blood pressure (hypotension).
  • Rapid peeling of the palms and feet soles, looking like scales.
  • Sunburn-like rashes all over the palms of your hands and soles of your feet.

The rashes are characterized by flatness, turning white if pressed. They may be hard to notice in people with dark skins.

Toxic shock syndrome predominantly affects young and middle-aged females especially those between 16 to 40 years. Females get toxic shock syndrome from pads or tampons usage.


Toxic shock syndrome is caused by strains of harmful bacteria that have been allowed to enter the human body. 

The causes of toxic shock syndrome involve three notable bacteria types, which are:

  1. Staphylococcus aureus (causing staphylococcal toxic shock syndrome).
  2. Streptococcus pyogenes (causing streptococcal toxic shock syndrome).
  3. Clostridium sordelli.


  • Receptacle a child get toxic shock syndrome?

Anybody can have toxic shock syndrome, including babies, boys, girls, women, and men. However, menstrual women are the most affected group, carrying approximately 50% of TSS patients. The syndrome is rarely found in children.

  • Why do tampons cause TSS but not menstrual cups?

Menstrual cups collect blood rather than absorb it. Hence, using these cups while menstruating is safer to prevent physical contact between bacteria and the vagina. It would be best if you didn’t use tampons.

  • Is it better to wear a pad or a tampon?

The rate of getting toxic shock syndrome from tampons is higher than getting toxic shock syndrome from pads. Therefore, it is better to use a sanitary pad because it proves safer than tampons. 

Pads reduce the spread of bacteria into your body. In addition, they do not carry risks of vaginal infection as they stick to your underwear, whereas tampons are inserted into the vagina.

  • What per cent of people get toxic shock syndrome?

It is estimated that around 3─5 people out of 100,000 get affected by TSS in the United States a year. National Organization for Rare Diseases (NORD) estimates that tampon-related TSS occurs in 1 out of 100,000 menstruating women a year. In world statistics, toxic shock syndrome (TSS) affects only less than 1% of the total world population.

  • Can toxic shock syndrome go away by itself?

TSS (toxic shock syndrome) cannot go away on its own. It needs immediate treatment to secure a minimal 99% success rate. If left untreated (more than 14 days after onset), TSS can be fatal.



  1. Todd J, Fishaut M, Kapral F, Welch T. Toxic-shock syndrome associated with phage-group-I Staphylococci. Lancet. 1978 Nov 25. 2 (8100):1116-8.
  2. mayoclinic 
  3. emedicine