How to Reduce Your Risk of Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a rare, potentially life-threatening condition. Although scientists have recognized a connection between tampons and cases of TSS,

At least half of reported staphylococcal TSS cases are not related to menstruation. Non-menstrual TSS can occur in a variety of clinical circumstances, including surgical and postpartum wound infections, mastitis, septorhinoplasty, sinusitis, osteomyelitis, arthritis, burns, cutaneous and subcutaneous lesions (especially of the extremities and perianal area), respiratory infections following influenza, and enterocolitis.

Learn more about how you can get toxic shock syndrome and what you can do to prevent it.

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Causes of Toxic Shock Syndrome

We live with bacteria every day. Some bacteria are beneficial, and even help our body function.

However, when certain types of bacteria enter your body and multiply, you can develop an infection. Your body's immune system responds to infection with immune cells called cytokines. If toxins released by these bacteria enter the bloodstream, they can affect major body systems. In turn, the body's immune response can overwhelm the body and cause a patient to go into shock.

Toxic shock syndrome is a complication of an infection by one or more of these different types of bacteria that release dangerous exotoxins as they multiply:

  • Staphylococcus aureus: This type is part of the body's normal "flora." It can live on the body without causing infection and most people can develop antibodies against it.
  • Clostridium sordellii: These bacteria are commonly found in the vagina and may not cause infection (unless they enter the bloodstream).
  • Streptococcus pyogenes: This type of bacteria is found in patients with weakened immune systems or other infections (like cellulitis).

Tampons—or in rare cases a menstrual cup or even a pad—can trap bacteria in the vagina, where they grow and multiply (and release toxins). From there, bacteria and toxins can pass through the cervix into the uterus and enter the bloodstream through the uterine wall, or enter the bloodstream through small microabrasions in the vagina.

Keep in mind that using tampons isn't the only way you can get toxic shock syndrome. In fact, only about half of all cases are found in menstruating women. Toxic shock syndrome can occur in people after surgery, or anyone with a wound or burn that could allow one of these bacteria to enter the body.

Although the condition is most commonly linked to tampon use in menstruating women, it can affect people of all ages, including men and children.

Toxic Shock Syndrome and Tampons

First, the good news: You don't have to quit using tampons in order to avoid TSS. Most cases of tampon-related TSS are a result of using tampon products the offer the highest absorbency and/or leaving them in for too long. When it comes to TSS, most medical professionals agree that it’s not the tampons that are the problem; rather, it's improper tampon use.

Manufacturers of tampons sold in the United States no longer use the materials or designs that were associated with early cases of TSS in the 1970s. The Food and Drug Administration (FDA) now also requires manufacturers to use standard measurements and labeling for absorbency and to print guidelines for proper use on the boxes.

Still, when it comes to the risk of a serious condition, it doesn't hurt to play it safe.

How to Prevent Toxic Shock Syndrome

If you use tampons, follow these safety tips to avoid toxic shock syndrome:

  • Always use the lowest possible absorbency tampon for your flow. This might mean using different absorbency levels at different points during your period. All tampon products in the United States use the standard Light, Regular, Super, and Super Plus labeling, according to FDA guidelines for tampon absorbency.
  • Change tampons at least every four to eight hours, and avoid wearing one to bed unless you plan on waking during the night to change it. When your flow is light, use sanitary napkins or mini pads.
  • Be sure to wash your hands thoroughly before and after inserting tampons. Staphylococci bacteria are often found on the hands.
  • If vaginal dryness is an issue, use a lubricant when inserting a tampon to avoid irritating the vaginal lining.
  • Do not use tampons—for vaginal discharge or any other reason—between menstrual cycles.
  • Do not use tampons if you have a skin infection near your genitals.
  • If you've had a case of TSS in the past, talk with your doctor before resuming tampon use.

When to Call Your Doctor

If you experience any signs of TSS—a sudden, high fever; vomiting or diarrhea; a sunburn-like rash on the palms of your hands and soles of your feet; redness of your eyes, mouth, and throat; or a drop in blood pressure—call your physician immediately. If toxic shock syndrome is left untreated, it can be fatal.

Treatment

If you develop toxic shock syndrome, you'll likely be hospitalized and treated with antibiotics and fluids to treat dehydration. Depending on your symptoms, your doctor may ask for blood and urine samples to test for the presence of a staph or strep infection. Since TSS can affect multiple organs, your doctor may also order other tests like a CT scan, lumbar puncture, or chest X-ray.

A Word From Verywell

Selecting a menstrual product to use during your monthly cycle is an individual decision. If you use tampons, it's important to understand how to use them properly, and how misuse can contribute to the risk of developing toxic shock syndrome. Talk to your doctor if you have questions about how to use tampons safety to avoid TSS.

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Article Sources
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  2. Cleveland Clinic. Toxic shock syndrome. Updated July 11, 2018.

  3. Bartlett P., Reingold AL, Graham DR. Toxic shock syndrome associated with surgical wound infectionsJAMA. 1982;247(10):1448. doi:10.1001/jama.1982.03320350052030

  4. U.S. Food & Drug Administration. The facts on tampons—and how to use them safely. Updated September 30, 2020.