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Toxic Shock Syndrome: Tampons and More

PD_Character Studies_SS32014Toxic 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 small cuts, tears, 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 begin suddenly, usually happen during or following a menstrual period. These symptoms include:

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 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 call for emergency medical services right away.

If TSS is suspected, treatment will be started as soon as possible. When 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:

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:

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 Congress of Obstetrics and Gynecology

US Food and Drug Administration


Health Canada

Women's Health Matters


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Staphylococcal toxic shock syndrome. EBSCO DynaMed Plus website. Available at: Updated August 12, 2016. Accessed May 3, 2017.

Streptococcal toxic shock syndrome. EBSCO DynaMed Plus website. Available at: Updated March 20, 2017. Accessed May 3, 2017.

Toxic shock syndrome. Kid's Health—Nemours Foundation website. Available at: Updated June 2014. Accessed May 3, 2017.

Last reviewed May 2017 by Michael Woods, MD, FAAP  Last Updated: 5/29/2015