Toxic Shock Syndrome (TSS), explained


“30% of the menstruators who get TSS are under the age of 19. In addition, women who have gotten TSS once are more likely to get it again.”

When I first started my period in my teens, I was introduced to a whole new world of monthly symptoms – back pain, cramps, and terrible mood swings (you know – the ones that give you the superpower to kill someone with just one look).  

And then, I was warned about the dangers of toxic shock syndrome.

First of all, I was absolutely terrified of the disease for years – without actually knowing anything about it – and my overactive imagination drove me to triple-check that every new strain of flu I caught was not, in fact, the dreaded TSS.

I know I was not the only one who clung to panic as protection rather than arming myself with knowledge (so, don’t be embarrassed). But now, as an adult, I want to make sure that others are equipped with the education they need.

While we can all soothe ourselves with the knowledge that TSS is a rare disease, it is still a pretty serious one. We can all benefit from learning how to lessen the chances of contracting it – plus, it’s a good idea to get familiar with the symptoms in order to visit the doctor when necessary.

What is Toxic Shock Syndrome?

Toxic shock syndrome is a rare and sometimes fatal complication of certain bacterial infections. It is most commonly caused by toxins produced by the Staphylococcus aureus (staph) bacteria. On some occasions, it is related to toxins from Streptococcus pyogenes or Group A streptococcus (strep).

Who can get toxic shock syndrome (TSS)?

Although toxic shock is normally associated with the use of tampons, it can affect anyone and everyone: Children, men, and postmenopausal women. Forgotten tampons are not the only thing that can cause TSS. Skin wounds, surgical wounds or procedures, and the use of products like menstrual cups, contraceptive sponges, or diaphragms may also increase the chances of developing toxic shock syndrome.

Around half of the TSS cases reported each year, however, do affect menstruating women. And the illness has been specifically connected to super-absorbent tampons (along with a few cases linked to menstrual cup use). 

How long has TSS been a known disease?

Toxic shock syndrome first hit public consciousness in 1980 when there was an outbreak of the syndrome, with over 800 cases and 35 deaths reported.

While the Center for Disease Control linked it to menstruating women, especially those using tampons, it wasn’t immediately clear exactly why the illness was happening. After all, tampons weren’t exactly groundbreaking technology.  

A panic quickly spread, and a frenzied media jumped on the story as the number of cases seemed to climb higher every day. The words “toxic” and “shock” were terrifying enough on their own – but then gluing them together in association with tampons… Could Stephen King have come up with something scarier?

Women started making the switch to pads in droves — like, who wouldn’t?

The connection was finally made to the high-absorbency tampons, especially “Rely” tampons, which were made of polyester foam and infused with chemicals as part of a race within the industry to come up with a bigger and better product. They were after absorbency, in particular. 

These and other high-absorbency tampons were quickly pulled off the market, and new regulations required tampon makers to have warnings about TSS be printed on all tampon products. Soon after, the number of toxic shock syndrome cases declined.

However: In recent years, we’ve seen an uptick in numbers. In 2016, there were five cases reported across a three-month period in Michigan. Health authorities wondered if it had to do with a lack of public awareness – a possibility that is especially worrying.

Signs and symptoms of Toxic Shock Syndrome

TSS symptoms include:

  • A sudden high fever
  • Headache
  • Muscle aches
  • Redness of eyes, mouth, and throat
  • Sunburn-like rash
  • Low blood pressure
  • Abnormalities in multiple systems and organ damage
  • A dramatic peeling of areas such as the hands and feet

30% of the menstruators who get TSS are under the age of 19. In addition, women who have gotten TSS once have a higher risk of TSS.

Toxic Shock Syndrome Treatment & Prognosis

Luckily, modern medicine is able to treat most cases successfully. But even then, it involves a stay in the hospital and IV fluids along with antibiotics. In some cases, a stay in the intensive care unit or surgery is also needed.

Indeed, the worst cases can be life-threatening. Some severe cases also lead to the amputation of a limb, which sadly occurred when model Lauren Wasser lost her leg to TSS in December 2017.

Often, those who suffer the most are those who do not seek medical attention rapidly enough. This is because, in the beginning, toxic shock syndrome symptoms are similar to viral infection or flu symptoms. If, during your period, you think you may have symptoms of TSS, it’s important to get checked immediately (like three days ago last Wednesday-immediately).

What causes TSS?

In menstruating women, there is basically one route to TSS: The uninvited guest known as staphylococcus aureus. Staph aureus is a bacteria that normally lives on our skin and doesn’t cause trouble. However, it’s thought that when a tampon is inserted, it drags some staph aureus from the skin into the vagina, riding on the tampon, as it were.

Tampons which have been left in for too long provide a warm, welcoming environment for these bacteria to flourish before they overstay their welcome and invite themselves to the afterparty in your body, where they really begin to cause problems by producing toxins.

These toxins are superantigens that prompt the immune system to massively overreact to an infection, causing the body to go into shock as inflammation spreads and a fever rises. 

Basically, your uninvited guests have broken into your best tequila, gotten drunk and then puked all over your furniture, and when the neighbors called for the police, the SWAT team arrived instead. 

Scientists suggest that women who are affected by TSS may have an immune system that doesn’t fight the bacteria off in the same way as the majority of the population. They lack, essentially, a protective anti-toxin antibody. This is why women who’ve had TSS once are often at increased risk of subsequent infection and should never place products, tampons or otherwise, in the vagina.

Completely freaked out? Remember that TSS is still extremely rare and there are LOTS of things you can do to reduce your chances of contracting it.

How to prevent TSS

Here are four simple rules to preventing toxic shock syndrome:

  1. Never wear a period product for longer than indicated by the manufacturer. For tampons, the maximum is eight hours; for most menstrual cups, it’s 12 hours. 
  2. Don’t use “super” absorbency tampons.
  3. Avoid wearing tampons overnight.
  4. Wash your hands thoroughly before and after changing your period product.

Ignore any urban myths floating around that natural or organic cotton tampons will safeguard you. This isn’t true. And, unfortunately, there is nothing you can do to completely safeguard yourself from tampon-related TSS; indeed, the model who lost her leg reported that she had changed her tampon three or four times the day she contracted the illness. If you experience any signs of TSS, seek medical care immediately.

Really, to improve peace of mind, it would be better to use a product with no reported cases of TSS to date— such as a menstrual disc. Menstrual discs offer many of the same benefits as tampons, and then some. They’re worn internally, ideal for active lifestyles, only have to be changed every 12-hours, and offer worry-free coverage during your period.

So, no need to switch back to pads. 

This article is informational only and is not offered as medical advice. It does not substitute a consultation with your physician. If you have any gynecological/medical concerns or conditions, please consult your physician. 

© 2023 The Flex Company. All Rights Reserved.