Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a sometimes life-threatening form of bacterial poisoning usually associated with Staphylococcus or Streptococcus bacteria. Very few people get TSS. On average, it affects approximately 3 out of every 100,000 men, women, and children in the United States, and most of them recover without any lingering problems.

What Is Going On?

Between October 1979 and May 1980, doctors all over the United States began reporting a new illness to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. Fifty-five women between the ages of 13 and 52 had shown up in doctors’ offices and in hospitals with symptoms of serious infections. The cooperation of doctors, health officials, epidemiologists, and laboratory scientists in the months that followed revealed a surprising coincidence: All the women were menstruating and used tampons * . This discovery led to recommendations that reduced the risk for the illness.

The arm of a patient with a rash (resembling measles) resulting from toxic shock syndrome. CDC.

The arm of a patient with a rash (resembling measles) resulting from toxic shock syndrome. CDC.

What Is Toxic Shock?

* , but can cause disease under certain circumstances.

Introducing Staphylococcus aureus

The staphylococci were among the first human disease-causing organisms to be discovered. They grow in various shapes, including irregular bulky clusters from which they get their name (the Greek word staphulé means “grapelike”). Staphylococci are the most common causes of the infections that people get in hospitals. In fact, they are at the root of about 2 million hospital infections each year. Various kinds of staphylococci exist. Some are particularly dangerous to people whose systems are already weak from other diseases.

S. aureus, a bacterium that causes toxic shock syndrome, is a major public health worry because it is very destructive and the infections it causes can be hard to treat.

For reasons scientists continue to try to understand, certain forms of bacteria sometimes produce, or secrete, poisonous substances called toxins. People whose bodies are not equipped to fight these toxins may develop a severe reaction to them called toxic shock syndrome. In humans, the toxin does not poison the cells directly. Instead, it stimulates the immune cells (the body's defenders against disease) to secrete huge amounts of cytokines (SI-to-kines), which are proteins that act on other cells. The action of these cytokines produces the symptoms of TSS.

In 1987 experts recognized a second kind of TSS, which is caused by Streptococcus (strep-to-KOK-us) bacteria and called streptococcal TSS (STSS). This illness behaves similarly to TSS, but it is rarer and is related to injured skin and wounds. It is not associated with tampon use.

How Does a Person Get Toxic Shock?

Anyone can get TSS. TSS is not contagious like the cold or flu, but a person who has the bacteria on his or her hands can infect areas of broken skin or wounds anywhere on the body. Half of TSS cases occur in women who use tampons during menstruation * or who have had injuries to the vagina from other causes, and half are related to infections arising from burns, insect bites, chickenpox blisters, or wounds resulting from surgery.

Signs and Symptoms

Symptoms for TSS are vomiting, a high fever, diarrhea, and muscle aches. A sunburn-like rash develops over the body during the first two days of illness. Curiously, the place on the body where the bacteria are multiplying and producing toxin may appear perfectly normal. The early signs and symptoms of TSS go away within a few days. As the rash heals, the skin on the torso, face, hands, and feet begins to peel. Later symptoms may include low blood pressure and heart and kidney failure.

Most people with TSS recover in 7 to 10 days, but 3 percent of people who get TSS die from it, mainly because they do not get treatment for it. People are more likely to die from TSS that is unrelated to menstruation.


The early symptoms of TSS may resemble those of severe allergic drug reactions or other illnesses. Lacking any other explanation, a doctor will suspect TSS in certain patients, such as women who use vaginal methods of birth control (for example, a diaphragm) or anyone who has recently had an operation. A blood test can confirm the diagnosis.

How Is TSS Treated?

* to remove waste products from the blood.

Can Toxic Shock Syndrome Be Prevented?

On average, toxic shock syndrome affects approximately 3 out of every 100,000 men, women, and children in the United States. No sure way exists to prevent TSS, but women can take precautions against it. Menstruating women should avoid using superabsorbent tampons; they should change tampons frequently and never leave a tampon inserted overnight. They also should wash their hands before and after inserting tampons. Girls and women who have had TSS should check with their doctor before using tampons again.

Naming Bacteria

Bacteria, like all other organisms, have a two-word scientific name. The scientific name is a pair of Latin words that identify the species in the same way that a person's name identifies the person. The first word is the genus name, and the second word is the species name. One genus can have many species in it. For example, some members of the genus Staphylococcus are named Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus saprophyticus to distinguish them from one another. Like members of a family, they are all related, but each acts in a different way.

See also Bacterial Infections • Shock • Staphylococcal Infections • Streptococcal Infections


Books and Articles

Nordqvist, Christian. “What Is Toxic Shock Syndrome (TSS)? What Causes Toxic Shock Syndrome?” Medical News Today, September 15, 2014. (accessed November 17, 2015).

Venkataraman, Ramesh. “Toxic Shock Syndrome.” Medscape, April 16, 2015. (accessed November 17, 2015).


MedlinePlus. “Toxic Shock Syndrome.” U.S. National Library of Medicine. (accessed November 17, 2015).

NHS Choices. “Toxic Shock Syndrome.” National Health Service. (accessed November 17, 2015).


Centers for Disease Control and Prevention. 1600 Clifton Rd., Atlanta, GA 30329-4027. Toll-free: 888-674-6854. Website: (accessed November 17, 2015).

Office on Women's Health. Department of Health and Human Services, 200 Independence Ave. SW, Room 712E, Washington, DC 20201. Telephone: 202-690-7650. Website: (accessed November 17, 2015).

* tampon is a plug of cotton or other material placed in the vagina during menstruation to absorb menstrual blood and other fluids.

* vagina (vah-JY-nah) is the canal, or passageway, in a woman that leads from the uterus to the outside of the body.

* menstruation (men-stroo-AY-shun) is the discharge of the blood-enriched lining of the uterus. Menstruation normally occurs in females who are physically mature enough to bear children. Most girls have their first period between the ages of 9 and 16. Menstruation ceases during pregnancy and with the onset of menopause. Because it usually occurs at about four-week intervals, it is often called the monthly period.

* dialysis (dye-AL-uh-sis) is a process that removes waste, toxins (poisons), and extra fluid from the blood. Usually dialysis is done when a person's kidneys are unable to perform these functions normally.

  This information is not a tool for self-diagnosis or a substitute for professional care.