Toxic shock syndrome

Toxic shock syndrome (TSS) is a rare but life-threatening condition caused by bacteria getting into the body and releasing harmful toxins.

It's often associated with tampon use in young women, but it can affect anyone of any age – including men and children.

TSS gets worse very quickly and can be fatal if not treated promptly. But if it's diagnosed and treated early, most people make a full recovery.

Symptoms of toxic shock syndrome

The symptoms of toxic shock syndrome (TSS) start suddenly and get worse quickly. They include:

• a high temperature
• flu-like symptoms, such as a headache, feeling cold, feeling tired or exhausted, an aching body, a sore throat and a cough
• feeling and being sick
• diarrhoea 
• a widespread sunburn-like rash
• lips, tongue and the whites of the eyes turning a bright red
• dizziness or fainting
• difficulty breathing
• confusion

Sometimes you may also have a wound on your skin where the bacteria got into your body, but it may not look infected.

When to get medical advice

Toxic shock syndrome (TSS) is a medical emergency.

While these symptoms could be due to a different condition, it's important to contact your GP, a local out-of-hours service, or NHS 111 as soon as possible if you have a combination of these symptoms.

It's very unlikely that you have TSS, but these symptoms should not be ignored.

Go to your nearest A&E department or call 999 and ask for an ambulance immediately if you have severe symptoms or they are rapidly getting worse.

If you're wearing a tampon, remove it straight away. Also tell your doctor if you've been using a tampon, recently had a burn or skin injury, or if you have a skin infection such as a boil.

If a doctor suspects you have TSS, you'll be referred to hospital immediately.

Treatment for toxic shock syndrome

If you have toxic shock syndrome (TSS), you'll be admitted to hospital and may need to be treated in an intensive care unit.

Treatment for TSS may involve:

• antibiotics to treat the infection
• in some cases, purified antibodies that have been taken out of donated blood, known as pooled immunoglobulin, may also be given to help your body fight the infection
• oxygen to help with breathing
• fluids to prevent dehydration and organ damage
• medicine to help control blood pressure
• dialysis if your kidneys stop functioning
• in severe cases, surgery may be needed to remove dead tissue. Rarely, it may be necessary to amputate the affected area

Most people will start to feel better within a few days, but it may take several weeks before you're well enough to leave hospital.

Causes of toxic shock syndrome

Toxic shock syndrome (TSS) is caused by either staphylococcus or streptococcus bacteria.

These bacteria normally live on the skin and in the nose or mouth without causing harm, but if they get deeper into the body they can release toxins that damage tissue and stop organs working.

These things can increase your risk of getting TSS:

• using tampons – particularly if you leave them in for longer than recommended or you use "super-absorbent" tampons
• using female barrier contraceptives, such as a contraceptive diaphragm or cap
• a problem with your skin, such as a cut, burn, boil, insect bite or a wound after surgery
• childbirth
• using nasal packing to treat a nosebleed 
• having a staphylococcal infection or streptococcal infection, such as a throat infection, impetigo or cellulitis

TSS is not spread from person to person. You do not develop immunity to it once you've had it, so you can get it more than once.

Preventing toxic shock syndrome

The following things can reduce your risk of toxic shock syndrome (TSS):

• treat wounds and burns quickly and get medical advice if you notice signs of an infection, such as swelling, redness and increasing pain
• always use a tampon with the lowest absorbency suitable for your period
• alternate between tampons and a sanitary towel or panty liner during your period
• wash your hands before and after inserting a tampon
• change tampons regularly – as often as directed on the pack (usually at least every 4 to 8 hours)
• never have more than one tampon in your vagina at a time
• when using a tampon at night, insert a fresh tampon before going to bed and remove it when you wake up
• remove a tampon at the end of your period
• when using female barrier contraception, follow the manufacturer's instructions about how long you can leave it in

It's a good idea to avoid using tampons or female barrier contraception if you've had TSS before.

Page last reviewed: Tue Sep 2022 Next review due: Tue Sep 2022