What is Toxic Shock Syndrome?

Many women may have heard from mother figures or other women in their lifetime that continuing to use the same tampon past 6 hours will cause toxic shock syndrome (TSS), perhaps without ever truly knowing what it is, only knowing that it does not sound good. Meanwhile, other women throw caution to the wind, often continuing to use the same tampon for a whole day with no consequences. Did you know there’s more to TSS than time with a tampon in?

Toxic shock syndrome is a rare reaction to certain types of bacterial infections that can be very serious. Namely, staphylococcus aureus (staph infection), and streptococcus pyogenes (Group A Strep), which travel through the bloodstream and can result in septic shock, kidney and other organ failures, and at the most extreme, death. With proper knowledge, however, this is preventable.

Despite this connection to tampons, TSS can also be caused by other menstrual products or contraceptives that are considered foreign objects in the vagina, including menstrual cups, diaphragms, and birth control sponges. TSS may also be the result of other wound- or surgery-related infections, meaning that it can affect anybody, regardless of reproductive age or biological sex.

TSS is more commonly associated with tampons because of a history of high absorbency tampons sending women to the intensive care unit (ICU). These have since been discontinued, except for maybe a super plus or ultra size, but women now tend to actively choose different sizes meant for different flows. Tampons continue to be the most common source of TSS, likely because of their ability to house and accelerate bacterial growth, spreading through the cervix and urethra. Additionally, tampons can often make small cuts on the vaginal walls, spreading infection through the bloodstream.

Symptoms

Common symptoms of TSS usually appear quite suddenly and tend to progress quickly.

• Flu-like symptoms, such as fever, chills, body aches, etc.,
• Nausea and vomiting,
• Diarrhea,
• A sunburn-like rash on the palms of the hands and soles of the feet, which may also begin peeling,
• Dizziness, lightheadedness, and fainting,
• Low blood pressure,
• Redness and soreness in the eyes and throat,
• Headaches, confusion, and seizures.

The most common of these symptoms are fever, rash, and low blood pressure at the onset. These may be followed by the other flu-like symptoms such as nausea, vomiting, headaches, and a sore throat.

What Can be Done About It

If you or a loved one is experiencing these symptoms, it’s important to seek medical assistance immediately. If TSS progresses further, there may be severe damage to internal organs without help. Typically, you will be admitted to the ICU and treated with several different approaches while healthcare professionals work to find the underlying bacterial cause.

• Antibiotics,
• Medication to regulate blood pressure,
• Fluids provided intravenously (IV) to prevent organ damage, and
• The removal of the tampon or foreign object.

Additional treatments after this point will likely center around the underlying cause, as well as any adverse complications that may have resulted from the infection spreading through the body.

It’s important to remember that TSS is rare and preventable. Avoiding excessive tampon use and the use of tampons that are too absorbent for the day’s level of flow can help. You may also try wearing menstrual pads at night or alternating between pads and tampons. Avoid using tampons on the lightest days of your period and reach for pantiliners or very light pads. Many women know that a light size is still sometimes too large for their lightest day.

TSS is more likely in those who have had it before. If you are still recovering, it is very important to avoid tampon use or even wearing a menstrual pad for too long (though it is rare, these may still cause a vaginal infection). Always speak with a medical professional if you are concerned about TSS.

Resources:

Atchade, E., De Tymowski, C., Grall, N., Tanaka, S., & Montravers, P. (2024). Toxic shock syndrome: A literature review. Antibiotics, 13(1), 96. https://doi.org/10.3390/antibiotics13010096 

Auger, N., Carrier, F. M., Waechter, J., Brousseau, É., Maniraho, A., Ayoub, A., & Bégin, P. (2024). Long-term outcomes of patients with toxic shock syndrome: A matched cohort study. Journal of Infection, 89(2), 106213. https://doi.org/10.1016/j.jinf.2024.106213 

Ross, A., & Shoff, H. W. (2023). Toxic Shock Syndrome. In StatPearls. StatPearls Publishing.

Strakian, L., & Karia, S. (2025). Toxic shock syndrome secondary to Group A streptococcus infection: A case report. Case Reports in Women’s Health, 45. https://doi.org/10.1016/j.crwh.2024.e00679