Toxic Shock Syndrome (TSS) is a rare but serious medical condition caused by toxins produced by certain types of bacteria. Although TSS has been linked to tampon use, it can affect anyone, including men, women and children, and can occur for reasons unrelated to menstruation.
When associated with menstruation, TSS is most commonly linked to prolonged use of tampons. However, it has also been reported, although very rarely, in people who use menstrual cups and menstrual discs.
TSS is a medical emergency that requires immediate treatment. Recognising the symptoms early and seeking urgent medical care can save lives.
What is Toxic Shock Syndrome?
Toxic Shock Syndrome is a severe illness caused when toxins released by certain bacteria enter the bloodstream and trigger a serious reaction throughout the body.
The bacteria most commonly associated with TSS are:
• Staphylococcus aureus (Staph bacteria); and
• Streptococcus pyogenes (Group A Streptococcus).Many people naturally carry these bacteria on their skin or in their nose without becoming ill. In rare situations, however, the bacteria produce toxins that can lead to TSS.
Is Toxic Shock Syndrome Only Caused by Tampons?
No.
Although TSS became widely known because of its association with tampons, it can also occur:
• after surgery;
• following childbirth;
• from infected cuts, burns or wounds;
• with skin infections;
• after using nasal packing; and
• in rare cases, during the use of menstrual cups or menstrual discs.Most people who use tampons or other menstrual products will never develop TSS.
Who is at Risk?
Anyone can develop TSS, but the risk may be slightly higher if you:
• leave a tampon in for longer than recommended;
• use a tampon with a higher absorbency than necessary;
• forget to remove a tampon;
• do not wash your hands before inserting or removing internal menstrual products;
• have an infected wound or skin infection; or
• have recently had surgery or given birth.TSS remains very uncommon, but because it can become serious quickly, everyone should know the warning signs.
Signs and Symptoms
Symptoms usually develop suddenly and may worsen rapidly.
They may include:
• a sudden high fever;
• chills;
• vomiting;
• diarrhoea;
• dizziness or feeling faint;
• confusion;
• muscle aches;
• headache;
• a widespread red rash that may resemble sunburn;
• redness of the eyes, mouth or throat; and
• low blood pressure.Some people may faint because of the sudden drop in blood pressure.
As the illness progresses, it can affect several organs, including the kidneys, liver, lungs and heart.
What Should You Do if You Think You Have TSS?
If you develop symptoms of TSS while using a tampon, menstrual cup or menstrual disc:
1. Remove the menstrual product immediately.
2. Seek emergency medical care without delay.
3. Tell the healthcare professional that you were using an internal menstrual product.Do not wait to see if the symptoms improve on their own.
Early treatment greatly improves recovery.
How is Toxic Shock Syndrome Diagnosed?
Healthcare professionals diagnose TSS by:
• asking about your symptoms;
• reviewing your medical history;
• performing a physical examination;
• checking your blood pressure;
• carrying out blood tests and other laboratory investigations; and
• identifying any possible source of infection.Because symptoms can resemble those of other serious illnesses, prompt medical assessment is essential.
How is Toxic Shock Syndrome Treated?
Treatment usually takes place in hospital and may include:
• intravenous (IV) fluids;
• antibiotics to treat the bacterial infection;
• medicines to support blood pressure if needed;
• oxygen or breathing support in severe cases; and
• treatment of any wound or infection that may have caused the illness.Most people recover fully when TSS is recognised and treated early.
How Can TSS Be Prevented?
Although TSS cannot always be prevented, the risk can be reduced by using menstrual products safely.
If you use tampons:
• wash your hands before and after inserting or removing a tampon;
• use the lowest absorbency needed for your menstrual flow;
• change tampons every 4 to 8 hours;
• never leave a tampon in for longer than 8 hours;
• avoid using tampons between periods; and
• remember to remove your last tampon at the end of your period.If you use a menstrual cup or menstrual disc:
• wash your hands before insertion and removal;
• empty the cup or disc as recommended by the manufacturer;
• clean reusable products according to the manufacturer’s instructions; and
• replace products when recommended.Possible Complications
Without prompt treatment, TSS can lead to serious complications, including:
• shock;
• kidney failure;
• liver problems;
• breathing difficulties;
• damage to multiple organs; and
• in severe cases, death.These complications are uncommon when treatment is received early.
When Should You Seek Emergency Medical Care?
Seek emergency medical attention immediately if you:
• develop a sudden high fever while using a tampon, menstrual cup or menstrual disc;
• develop a widespread rash together with fever;
• faint or feel extremely dizzy;
• become confused;
• have difficulty breathing; or
• experience vomiting or diarrhoea together with fever and weakness while using an internal menstrual product.Do not delay seeking care, as TSS can become serious within a short period.
Myths and Facts
Myth: Everyone who uses tampons will eventually develop TSS.
Fact: TSS is very rare, and most tampon users will never experience it.
Myth: Only tampon users can develop TSS.
Fact: TSS can occur in anyone and may develop from wounds, skin infections, surgery or childbirth.
Myth: Menstrual cups cannot be associated with TSS.
Fact: Although extremely rare, TSS has also been reported in menstrual cup users.
Myth: TSS will go away on its own.
Fact: TSS is a medical emergency that requires immediate treatment.
Frequently Asked Questions
- Is Toxic Shock Syndrome common?
No. TSS is a rare condition, but because it can become life-threatening very quickly, it is important to recognise the symptoms.
- Can I still use tampons safely?
Yes. Tampons are safe for most people when used correctly. Always follow the manufacturer’s instructions, use the lowest absorbency needed and change them regularly.
- Can I sleep while wearing a tampon?
Yes, provided the tampon is not left in for more than 8 hours. If you are likely to sleep longer than this, consider using another menstrual product.
- Can TSS happen more than once?
Yes. A person who has had TSS can develop it again, so they should discuss future menstrual product choices with a healthcare professional.
Key Messages
• Toxic Shock Syndrome (TSS) is a rare but serious medical emergency.
• Although often associated with tampons, TSS can occur for several reasons and is not limited to menstruation.
• Most people who use tampons, menstrual cups or menstrual discs will never develop TSS.
• Reduce your risk by using internal menstrual products correctly, washing your hands and following the recommended wear times.
• Seek emergency medical attention immediately if you develop a sudden high fever, rash, dizziness, confusion or other symptoms of TSS while using an internal menstrual product.Related Articles
• Choosing the Right Menstrual Product
• Menstrual Hygiene 101
• Managing Your Period at School, Work and Daily Life
• When Period Pain Isn’t NormalKnowledge Hub Series: Period Talk Uganda – Evidence-Based Menstrual Health Resources