TSS
Symptoms of TSS begin two to four days after infection and include headaches, sleepiness, fever, and a rash,
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  • Toxic shock syndrome (TSS) is a potentially fatal bacterial infection that puts the body into a state of shock, resulting in organ failure. 
  • The symptoms of TSS can manifest two to four days after infection, which often include a fever, a rash, vomiting, and confusion. 
  • TSS can affect anyone, but surgeries, gynecological procedures, and wounds can increase the risk. 
  • Wearing a tampon in for too long may cause TSS, so it’s extremely important to change regularly.
  • Visit Insider’s Health Reference page for more advice. 

Toxic shock syndrome (TSS) is a rare and potentially life-threatening complication of a bacterial infection. It develops when toxins from bacteria, such as Staphylococcus aureus (staph) or group A Streptococcus (strep), enter the bloodstream and cause the body to go into shock, where the organs can’t function properly because of the lack of oxygen and nutrients.

“When most people think of TSS, they associate it with menstruation or using tampons, but it is important to point out that about 50% of cases actually occur in non-menstruating women, men, and children,” says Mishka Peart, MD, OB-GYN, and fellow at Physicians for Reproductive Health.

The condition is also associated with burns, post-surgical or postpartum infections, and wound infections. Some of the major symptoms include sudden high fever, a sunburn-like rash and peeling, and redness in the eyes, mouth, or throat.

If you think you might be experiencing TSS, seek medical attention immediately because early treatment is crucial for survival. Learn about the causes, risk factors, and symptoms of toxic shock syndrome.

What is toxic shock syndrome?

Toxic shock syndrome occurs when TSS-causing bacteria produce toxins that bypass a specific interaction with the immune system, which leads to an uncontrolled “overreaction” of the body. It produces an overwhelming amount of cytokines, chemicals that control the immune response, which can manifest as a fever, rash, shock, or organ failure, says Julie Hakim, MD, FRCS(C), FACOG, assistant professor of obstetrics and gynecology at Baylor College of Medicine. 

The condition is caused by several types of bacteria. Staphylococcus aureus (staph) are more common in menstrual-associated TSS whereas Group A Streptococcus (strep) are usually found in the throat and on the skin. Meanwhile, clostridium sordellii is often associated with spontaneous, surgical, and medical abortions, as well as childbirth. Strep TSS is much more dangerous than TSS caused by other bacteria.

Toxic shock syndrome can rapidly progress to hypotension, or low blood pressure, which leads to organ failure. This is because toxins of TSS-causing bacteria trigger the whole body's immune response, and as a result, blood vessels widen to allow blood and antibodies to reach the part of your body that needs help, which - in the process - lowers blood pressure.

Risk factors of toxic shock syndrome

The most infamous risk for TSS is tampon use, but it's not the tampon itself that's the issue. 

According to Jessika Ralph, MD, MSCI, OB-GYN, and fellow at Physicians for Reproductive Health, you can introduce the bacteria from the skin of your hands and vulva onto the tampon as you place it. When you leave a tampon in for longer than eight hours, the bacteria have more opportunity to grow, enter the uterus through the cervix or bloodstream, and cause infection.

Therefore, to lower the risk, "it is best if a person changes their tampon every four to six hours using the minimal absorbency tampon they need, and washes their hands before and after changing their tampon," says Ralph.

Menstrual pads aren't associated with toxic shock syndrome, but menstrual cups, contraceptive sponges, and diaphragms can increase the risk. Aside from tampons, other risk factors for toxic shock syndrome include:

TSS from strep bacteria is a high risk for maternal mortality during pregnancy and can rapidly develop into sepsis with multi-organ failure, so early recognition of symptoms and thorough treatment are necessary.

Symptoms of toxic shock syndrome

Depending on where the infection is located in your body and what type of bacteria is causing it, there is a range of symptoms you may experience. If you're at risk for developing toxic shock and you you have one or a combination of the following symptoms, you should contact your doctor:

  • Muscle aches or fatigue
  • Sudden high fever with chills
  • Vomiting and diarrhea
  • A sunburn-like rash with skin peeling in your palms and soles
  • Nausea and confusion
  • Headaches or seizures
  • Redness in the eyes, mouth, or throat
  • Low blood pressure

Other symptoms include sleepiness, difficulty being aroused from sleep, or even hallucination, says Ralph. Once low blood pressure develops, you may experience more serious symptoms such as rapid breathing, faster heart rate, and organ failure.

TSS can be difficult to recognize because it often starts off with flu-like symptoms. If you recently experienced one or more of the risk factors for TSS and you have intense symptoms that worsen quickly, it's best to seek medical attention to err on the side of caution.

"In people who are menstruating, symptoms usually develop between two and five days after period onset and can progress quickly. If left untreated, it can become life-threatening within 48 hours," says Peart. According to Hakim, prompt recognition and aggressive management in the hospital can reduce mortality, so time is of the essence.

Serious complications are common with toxic shock syndrome. According to Peart, it may result in the removal of limbs, fingers, toes, or uterus during hospitalization.

"The most important long-term effect can be death," says Hakim. The mortality rate for staph TSS is about 3%, significantly lower than that for strep TSS, which ranges from 30% to over 50%.

Insider's takeaway

Although toxic shock syndrome is commonly associated with menstruating people, it can affect anyone. It develops when bacterial toxins enter the bloodstream. Some of the major risk factors include prolonged use of tampons, wound infections after surgery, and gynecological procedures.

You can reduce the risk of developing TSS from tampon use by changing your tampon every four to six hours and washing your hands before and after you do so. If you develop symptoms like a sudden onset of fever, muscle aches, and sunburn-like rashes with skin peeling, seek medical attention immediately.

"Most people make a complete recovery with early diagnosis and prompt treatment by a skilled medical team," says Peart. "Delaying seeking treatment increases the chance that you may experience a serious complication from TSS or even death."

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