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Toxic Shock Syndrome

Women's Health, Immune | March 21, 2018 | Author: Naturopath

Immune, women's health

Toxic Shock Syndrome

Toxic shock syndrome is an extremely rare illness that is caused by toxins produced by certain types of bacteria (Staphylococcus aureus or Group A streptococcus). The toxins stimulate an inflammatory response in the body leading to shock.

Most cases of toxic shock syndrome occur in women, with about 25% of cases in men.

The term toxic shock syndrome was coined in 1978 having been first described in children. In 1980 there was an outbreak of the illness among young menstruating women in the United States, which was linked to tampon use. 91% of cases reported by 1980 were in tampon users, and a newly recognised illness was born.

At its peak, the incidence of toxic shock syndrome reached 13.7 per 100,000 persons. By 1986 this number has substantially decreased to approximately 1 per 100,000 following some public health interventions that raised awareness and provided some guidelines regarding the proper use of tampons.

Symptoms of toxic shock

  • A sudden high fever (⩽ 38.9°C)
  • Low blood pressure
  • Vomiting or diarrhoea
  • Sunburn- like rash, especially on the palms and soles of the feet
  • Confusion
  • Muscle aches
  • Headaches

Toxic shock syndrome can be divided into two types:

Menstrual toxic shock syndrome

Approximately 50% of all toxic shock cases are associated with staphylococcal toxins due to the use of highly absorbent tampons (those that are labelled “super” or “suitable for heavy flow”).

Users of high-absorbency tampons have been found to have the highest risk; hence, the chances of getting the disease is directly linked to the absorbency of the tampon used. The risk prompted some manufacturers to withdraw highly absorbent tampons from the market. Additionally, since 1980 tampon manufacturers have removed three of the four synthetic ingredients. Current tampons are manufactured from cotton and/or rayon.

Nevertheless, users of any type of tampons have a higher risk than women who do not use tampons at all, especially if a single tampon is used continuously for consecutive days.

In Australia, all packs of tampons are required by the Department of Health to display the following warning:

IMPORTANT: Tampon use has been associated with Toxic Shock Syndrome (TSS). TSS is a rare but serious disease that may cause death. Read and keep the enclosed information.

How can I reduce my risk?

  • Avoid extended tampon use and change tampons frequently. 
  • Alternate tampon use with sanitary pads use during menstrual periods.
  • Alternatively, do not use tampons.
    • Seek medical advice before using tampons again if any warning signs of toxic shock syndrome have occurred in the past.

Non-menstrual toxic shock syndrome

Toxic shock that is not associated with the use of tampons can occur when bacteria, usually streptococcus, invade the body through a break in the skin or an abscess. This can happen due to wound infections following a burn or a surgical procedure, such as vaginal delivery, breast reconstruction, caesarean section, hysterectomy, liposuction, etc. There have also been reported cases of toxic shock caused by mosquito bites or by foreign medical objects in the body such as nasal packing and dialysis catheters.

Patients with diabetes or AIDS, as well as alcoholics, are at a greater risk of getting this type of toxic shock syndrome.

Non-menstrual toxic shock syndromeHow can I reduce my risk?

  • Wash your hands, especially after coughing and sneezing and before preparing foods or eating.
  • Keep wounds clean and watch for possible signs of infection such as redness, swelling, leaking, and pain at the wound site.
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Diagnosis of toxic shock syndrome

Diagnosing toxic shock syndrome is complex as there is no single test for identifying it. The diagnosis is based on presenting signs and symptoms.


Treatment usually includes Intravenous fluids and certain medications to raise blood pressure and improve blood flow to vital organs, as well as prompt administration of antibiotics to cover Staphylococcus aureus and group A streptococcus. Other treatment may be included, depending on the symptoms, and in some instances, surgery may be necessary in order to remove infected and dead tissue.

When should I go to hospital?

When should I go to hospital?Toxic shock syndrome is a rare but serious and potentially fatal disease. If you have a high fever along with a red rash and some of the toxic shock syndrome symptoms listed above, you should be taken to hospital immediately for an evaluation.

Do not drive yourself to hospital.

Symptoms can progress rapidly to life-threatening sepsis and multi-organ failure. Women who are menstruating and using a tampon should remove it.  Australia’s best online discount chemist


Department of Health 2017. Guidance on the regulation of tampons in Australia. Available at:

DeVries, A.S. et al., 2011. Staphylococcal toxic shock syndrome 2000-2006: epidemiology, clinical BMJ Best Practice 2018. Toxic shock syndrome - Symptoms, diagnosis and treatment. Available at:

features, and molecular characteristics. PloS one, 6(8), p.e22997. Available at:

Inokuchi, R. et al., 2015. Toxic shock syndrome. BMJ case reports. Available at:

Mayo Clinic  2017. Toxic shock syndrome.. Available at:

Ross, A. & Shoff, H.W., 2018. Toxic Shock Syndrome, StatPearls Publishing. Available at:

Sharma, H. et al., 2018. Clinical and Molecular Epidemiology of Staphylococcal Toxic Shock Syndrome in the United Kingdom. Emerging infectious diseases, 24(2), p.258. Available at:

Venkataraman, R. 2017. Toxic Shock Syndrome. Available at:

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