Everything You Need to Know About Toxic Shock Syndrome (TSS)

Whether you use tampons or menstrual cups during that time of the month, or diaphragms or sponges as a method of birth control, if you’re putting something in your vagina, it’s important to know about the risks, signs, and symptoms of toxic shock syndrome (TSS). 

Though TSS is incredibly rare, the symptoms can come on suddenly and the infection has the potential to be fatal. Your body and your overall health already give you enough to worry about—TSS shouldn’t have to be on that list.

Here’s everything you need to know about TSS, including, how to avoid contracting it and what to do if you’ve been infected. 

What is Toxic Shock Syndrome (TSS)? 

TSS is, in short, “a bacterial infection usually caused by staph bacteria in the vagina,” explains June Gupta, NP, Director of Medical Standards at Planned Parenthood Federation of America. 

While the bacteria usually exists in the vagina and is harmless, Gupta says that TSS “occurs when the bacteria gets into parts of the body where it’s not normally found and multiplies. Some strains of the bacteria, she says, can release toxins that result in the body going into shock.  

“Classically the syndrome is thought to occur in menstruating women but it can also affect men, children, and postmenopausal women,” notes Dr. Sherry A. Ross, author of she-ology. The Definitive Guide to Women’s Intimate Health. Period. 

Dr. Ross says that 50 percent of TSS cases occur in menstruating women who use super-absorbent tampons, and the other 50 percent occur in surgical and postpartum infections in wounds resulting from mastitis, burns, sinusitis, and skin lesions. 

When Are You at Risk of  Contracting TSS? 

“People who are menstruating or have recently given birth are at the highest risk of developing toxic shock,” says Gupta. 

If you have a heavier menstrual flow, you may use larger and more absorbent tampons, putting you at higher risk for TSS, says Dr. Perry. “Even if you have a light day and less blood flow, you still need to change your tampon every 4 to 8 hours and use small and less absorbent tampons,” she adds. 

What are the Signs and Symptoms of TSS? 

TSS can occur quickly and without warning, Dr. Perry says, so paying attention to the signs and symptoms is key. “TSS can start out as a fever, vomiting, muscle aches, headaches or diarrhea, and a rash that looks like a sunburn, especially on the hands and feet.” That rash, Dr. Perry says, is the hallmark sign of the skin-changing characteristics of TSS. 

However, as Gupta points out, “there is no reason to think you have TSS if you have a tampon in and are vomiting or experiencing other symptoms but don’t have a rash.” 

The symptoms of TSS, Dr. Perry warns, can progress into low blood pressure, ulcerations in mucous membranes such as your eyes, mouth, and throat, and ultimately cause difficulty breathing, limb amputation, and even death. 

If you notice you have any of these signs or symptoms (the illness with the rash), Gupta says you should immediately remove your tampon/menstrual cup/diaphragm, and contact your health care provider immediately. 

“A thorough exam, along with a woman’s [medical] history, is vital in establishing the diagnosis of TSS,” says Dr. Perry. 

How is TSS Treated? 

Whether you’ve gone to your healthcare provider or an emergency room, Gupta says the bacterial infection will likely be treated with an antibiotic. “In very few cases, surgery may be needed to remove dead or infected tissue,” she adds. 

In addition to antibiotics, Dr. Ross says that intravenous hydration and supportive care may be given to patients suspected to have TSS. She also notes that prolonged hospitalization is required to ensure the safety of someone who has contracted TSS.

“While it’s a relatively uncommon condition, TSS can be fatal if left untreated, so be sure to reach out to a health care provider immediately if you have symptoms,” Gupta says. “TSS is fairly easy to diagnose, and with proper treatment, most people will make a full recovery.” 

How Can You Prevent TSS? 

“There are steps you can take during your period to prevent TSS,” says Dr. Ross. “Tampons should be changed every 4 to 8 hours. Using the lowest absorbency tampon will also minimize your risk.” On lighter days, Gupta suggests using a pad at night instead of a tampon, “so you’re not constantly inserting one after another for your entire period.” 

When it comes to using menstrual cups, Dr. Ross says they should also be changed every 12 hours to avoid increasing your risk of TSS. 

“If you use the diaphragm or sponge as your birth control method,” Gupta says, “you should avoid keeping it in for extended periods of time or using it at all during your period to reduce your risk of TSS.” 

Having awareness of this infection is a key part of prevention, too. 

As Dr. Ross puts it, “You can never be too concerned or cautious about preventing TSS.  When you least expect it, TSS can occur. It’s important to know the signs and symptoms associated with this unpredictable and life-threatening disease.” 

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