Toxic shock syndrome can happen when a tampon is left in for too long.
Toxic shock syndrome is a bacterial infection that happens due to tampons being left inside a woman's vagina for too long.

What is Toxic Shock Syndrome?

What is toxic shock syndrome? Toxic shock syndrome (TSS) is a rare but potentially fatal bacterial infection. The condition can affect people of all ages but is most commonly linked to tampon use in menstruating women. TSS symptoms usually begin suddenly and progress rapidly, and people with the infection require immediate medical treatment and often need to be hospitalized.

In most cases, TSS can be prevented. Understanding the potential causes of the infection is key for reducing your risk of getting it. You should be aware of the signs and symptoms.

What Causes Toxic Shock Syndrome?

TSS is a bacterial infection caused by a toxin-producing strain of the Staphylococcus aureus bacteria. Usually, these bacteria live harmlessly on the skin and in the nose, mouth and vagina without causing illness. However, if they multiply rapidly, the toxins they produce can reach dangerous levels and may cause TSS.

Though TSS can affect anyone of any age, it most often occurs in menstrual women when tampons are left inside the vagina for too long. This is because blood-soaked tampons provide ideal conditions for bacteria to thrive and rapidly multiply, releasing toxins as they do so. If the tampon is left inside the vagina for long periods of time, these toxins build up and may enter the bloodstream, triggering TSS.

Tampons may also cause tiny cuts inside the vagina, which would the facilitate the absorption of bacterial toxins into the bloodstream. The risk of this is higher when tampons are used during “light flow” days, as dryness can cause excessive friction when the tampon is inserted.

TSS is also seen in people who use nasal packing in the event of a nosebleed and then leave the packing in place for long periods of time. Using contraceptive sponges, diaphragms and caps can also increase your risk of developing TSS.

Who is at Risk?

Most cases of TSS are seen in menstrual women who use tampons. Your risk of getting TSS may also be increased by:

  • Skin problems following surgery (such as cuts, burns, blisters or insect bites)
  • Open wounds
  • Childbirth
  • Staphylococcal or streptococcal infections (such as impetigo, cellulitis or throat infections)
  • Use of female barrier contraceptives (such as contraceptive diaphragms)
  • Using “super-absorbent” tampons
  • Using nasal packing in the event of nosebleeds
  • People who have had TSS before

Symptoms of Toxic Shock Syndrome

The symptoms of TSS are characterized by sudden onset and rapid progression. Common signs of TSS include:

  • A sunburn-like rash (may be widespread and can occur anywhere on the body)
  • Fever
  • Nausea and vomiting
  • Watery diarrhea
  • Flu-like symptoms (including sore throat, a cough, headache, muscle aches and general fatigue)
  • Confusion
  • Dizziness or fainting
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Complications of Toxic Shock Syndrome

TSS is a potentially life-threatening infection and can lead to serious complications if left untreated. These include:

  • Heart failure
  • Kidney failure
  • Liver failure
  • Shock (characterized by reduce blood flow throughout the body)

When Should You See a Doctor?

The symptoms of TSS are similar to those of flu and may be mistaken for a less serious illness. However, if you experience these symptoms after tampon use, surgery, childbirth, skin injury or infection, they may indicate TSS and you should contact a doctor immediately for a medical assessment.

TSS requires immediate treatment to reduce the risk of death and serious complications, and most people with the infection must be hospitalized.

Treatment for Toxic Shock Syndrome

TSS requires emergency care to reduce the risk of organ failure and death. This usually takes place in hospital and includes:

Removal of Bacterial Sources

TSS is usually caused by the build-up of bacteria on forgotten tampons and nasal packing. If this is the case, the first step of treatment is to remove this source of bacteria so the body can begin to fight the infection. If an infected wound is the cause of TSS, this will be thoroughly cleaned and any pus or blood will be drained from the wound.

Antibiotic Therapy

Immediate treatment with intravenous (IV) antibiotics is required to help people with TSS fight off the infection. This is typically administered in hospital, but patients may also have to continue antibiotic treatment for up to eight weeks at home once discharged.

IV Fluids

IV fluids are essential for treating shock and preventing dehydration in people with TSS.

Other Medications

Medications to reduce inflammation, stabilize blood pressure and boost the body’s immune system may also be given to people with TSS.


Kidney failure is a common complication of TSS. People with kidney failure will need to be treated with dialysis in hospital.

How to Prevent Toxic Shock Syndrome

Thankfully, TSS is a rare infection and your chances of getting it are generally very low. It is most often seen in menstruating women who use tampons, so switching to a reusable, silicone menstrual cup (like a Mooncup) can be an effective preventative step.

You can also reduce your risk of getting TSS by:

  • Changing tampons regularly (every four to eight hours)
  • Avoiding the use of “super-absorbent” tampons
  • Using pads on “light flow” days
  • Keeping tampons in a cool, dry place to prevent bacterial growth
  • Washing your hands regularly to remove bacteria
  • Keeping any wounds clean and changing dressing regularly (particularly after surgery)

In Review

TSS is a rare but life-threatening condition caused by a toxin-producing strain of the Staphylococcus aureus bacteria. It occurs when these bacterial toxins enter the bloodstream and can affect anyone of any age. However, the condition is most commonly associated with tampon-use in menstruating women (usually, when a tampon is left in for too long). Your risk of developing TSS is also higher after surgery, childbirth, staphylococcal or streptococcal infections, or if you use female barrier contraceptives.

Immediate antibiotic therapy and hospitalization is usually required for people with TSS. If left untreated, the infection can cause multiple organ failure and death. If you experience symptoms of TSS in combination with any of the mentioned risk factors, seek immediate medical care at your nearest ER department.