Toxic Shock Syndrome

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a serious illness that affects multiple systems of the body and is caused by toxins released by certain bacteria. Staphylococcus aureus (commonly referred to as “staph”) and Streptococcus pyogenes (usually referred to as group A Streptococcus or “strep”) are the two bacteria most often associated with toxic shock syndrome, although in rare cases other bacteria can cause the same symptoms.

Who gets TSS?

TSS is rare. Recognized groups at risk of S. aureus TSS include menstruating women using tampons, menstrual cups, or other inserted devices, women using diaphragms or contraceptive sponges, and anyone with a S. aureus infection of another body site. The risk is much lower now than it was in the past because tampon manufacturers have made changes so their products are safer. Streptococcal TSS is more likely to occur in the young, elderly, and persons with underlying conditions that weaken the immune system.

How is TSS spread?

TSS is a complication of infection and cannot be spread to others. However, the bacteria that cause the infections that can lead to TSS, S. aureus and Streptococcus, can be spread from person-to-person through direct contact.

What are the symptoms of TSS?

Common signs and symptoms include fever, muscle aches, vomiting and diarrhea, and a sunburn-like rash that later peels. Hypotension (low blood pressure), shock, multi-organ failure, and death can occur.

How soon after exposure do symptoms appear?

TSS can develop within 12 hours in some cases.

How is TSS diagnosed?

TSS is usually diagnosed by a physician based on an assessment of the patient’s signs, symptoms, and laboratory results.

What is the treatment for TSS?

Treatment includes antibiotics and supportive care (measures to help improve the symptoms of the disease). This may include intravenous (IV) fluids, medications to raise blood pressure, equipment to aid breathing, dialysis and other measures to counteract the effects of the toxins.

How can TSS be prevented?

Some TSS can be prevented by using the lowest absorbency tampon needed, changing tampons per the manufacturer’s directions, thoroughly washing menstrual cups, and by switching between tampons or menstrual cups and absorbent pads during each menstrual cycle. Diaphragm and contraceptive sponge users should follow the package instructions, which advise not to leave these in place for more than 30 hours.

Early recognition and treatment of staphylococcal and streptococcal infections can help prevent serious complications such as TSS.

How can I get more information about TSS?

• If you have concerns about TSS, contact your healthcare provider.
• Call your local health department. A directory of local health departments is located at the VDH Local Health Districts page.
• Visit the Centers for Disease Control and Prevention website at https://wwwn.cdc.gov/nndss/conditions/streptococcal-toxic-shock-syndrome/case-definition/2010/.

September 2018