Mayo Clinic Health Library

Toxic shock syndrome

Updated: 05-07-2011


Toxic shock syndrome is a rare, life-threatening complication of bacterial infection. It has been historically associated with the use of superabsorbent tampons and occasionally with the use of contraceptive sponges.

Often toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but the condition may also be caused by toxins produced by group A streptococcus (strep) bacteria.

While the syndrome can occur in menstruating women, it can also affect men, children and postmenopausal women. Risk factors for toxic shock syndrome include skin wounds and surgery.

Signs and symptoms of toxic shock syndrome develop suddenly, and the disease can be fatal. You can take steps to reduce your risk of toxic shock syndrome.



Possible signs and symptoms of toxic shock syndrome include:

  • A sudden high fever
  • Low blood pressure (hypotension)
  • Vomiting or diarrhea
  • A rash resembling a sunburn, particularly on your palms and soles
  • Confusion
  • Muscle aches
  • Redness of your eyes, mouth and throat
  • Seizures
  • Headaches

When to see a doctor
Call your doctor immediately if you experience the signs or symptoms of toxic shock syndrome. This is especially important if you're menstruating or have just finished menstruating and have been using tampons or if you have a skin or wound infection. Tell your doctor what your symptoms are and how long you've had them.



Toxic shock syndrome can happen to anyone. About half the cases of toxic shock syndrome occur in people who aren't menstruating, including older women, men and children.

Toxic shock syndrome has been associated with:

  • Using superabsorbent tampons
  • Wearing a diaphragm or contraceptive sponge
  • Having a staph or strep infection, especially if you have skin wounds or healing surgical incisions

Tampon use
Researchers don't know exactly how tampons may cause toxic shock syndrome. Some believe that when superabsorbent tampons are left in place for a long time, the tampons become a breeding ground for bacteria. Others have suggested that the superabsorbent fibers in the tampons can scratch the surface of the vagina, making it possible for bacteria or their toxins to enter the bloodstream.


Tests and diagnosis

There's no one specific test for toxic shock syndrome. You may need to provide blood and urine samples to test for the presence of a staph or strep infection. Samples from the vagina, cervix and throat may be swabbed for laboratory analysis.


Treatments and drugs

If you develop toxic shock syndrome, you'll likely be hospitalized and need antibiotics. Doctors will try to determine the source of the infection.

Along with antibiotics, you'll receive supportive care to treat the signs and symptoms of toxic shock syndrome. If your blood pressure begins to drop (hypotension), you'll need medication to stabilize it and fluids to treat dehydration.

The toxins produced by the staph or strep bacteria and accompanying hypotension may result in kidney failure. If your kidneys fail, you may need dialysis.



Menstrual toxic shock syndrome can be prevented by changing tampons frequently, at least every four to eight hours. Consider using the lowest absorbency tampon you can, and try to alternate using tampons and sanitary napkins whenever possible. Avoid using tampons at all when your flow is very light; use minipads instead.

Toxic shock syndrome can recur. People who've had it once can get it again. If you've had toxic shock syndrome or a prior serious staph or strep infection, don't use tampons at all.