Toxic shock syndrome

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have toxic shock syndrome, or who would like more information about it.

Toxic shock syndrome is a rare but serious type of blood poisoning caused by toxin-producing Staphylococcus and Streptococcus bacteria. It affects about 40 people each year in the UK. It can affect men, women and children of any age.

About toxic shock syndrome

Toxic shock syndrome (TSS) is caused by harmful substances called toxins released by bacteria belonging to the Staphylococcus and Streptococcus families.

Bacteria belonging to the Staphylococcus family such as S. aureus are usually responsible for TSS and are common in healthy people. About one in three healthy people carry the bacteria on their skin, or in their nose. Bacteria belonging to the Streptococcus family live on the skin, in the mouth, in the back of the throat and in the intestines.

TSS is often associated with tampon use in women but it can affect men, women and children of any age.

Symptoms of toxic shock syndrome

The symptoms of TSS tend to come on suddenly and include:

• a high temperature - 39°C or more
  
• vomiting
  
• diarrhoea
  
• red rash (rather like sunburn) which may peel, particularly on the hands and feet
  
• excessive tiredness
  
• aching muscles
  
• confusion
  
• feeling light-headed or dizzy

If you develop these symptoms you should contact your GP or the hospital immediately. If you are a woman wearing a tampon you should remove it as soon as you can.

Complications of toxic shock syndrome

TSS is a life-threatening condition and needs to be treated urgently. It can cause your blood pressure to drop and your body to go into 'shock', which means there isn't enough blood getting to your organs. This can damage your kidneys, liver and lungs.

Causes of toxic shock syndrome

Toxic shock syndrome (TSS) is caused by toxins released by bacteria belonging to the Staphylococcus and Streptococcus families. These are normal bacteria found on the skin and in the body and aren't harmful to healthy people. However, if your body is under particular stress, or if you have suffered trauma or illness, these bacteria can get into the blood stream and cause problems. For example TSS can develop after:

• a wound to your skin, for example after an operation
  
• a virus, especially chickenpox or influenza (flu)
  
• a bacterial infection, for example a bacterial throat infection
  
• nipple piercing

Women are most at risk of getting TSS:

• during menstruation - particularly if you're using tampons
  
• after childbirth
  
• when using an internal barrier contraceptive (such as a diaphragm)

You're also more at risk of TSS if you have long-term heart or breathing problems or diabetes.

Diagnosis of toxic shock syndrome

Your doctor will ask about your symptoms, examine you and take your blood pressure. He or she may also ask you about your medical history.

It's important that you tell your doctor if you have been wearing a tampon, had a recent injury (such as an accident or burn) or an operation. This can help your doctor identify how you got the infection.

Your doctor can usually diagnose TSS from your symptoms. He or she will take blood samples to identify which bacteria you are infected with.

Treatment of toxic shock syndrome

TSS is a serious and potentially life-threatening condition. You will need to go to hospital for treatment and probably be treated in the intensive care unit.

Your doctor will examine and clean and drain any possible sites of infection such as surgical wounds or burns. If you're wearing a tampon, internal contraceptive device or have any wound packing, it will be removed immediately.

You will have antibiotics and fluids through a drip to treat the infection and the shock.

You will be given oxygen through a mask and closely monitored. You may need intensive support if any organs are affected, for example, ventilation if your lungs are affected or kidney dialysis.

You may have drugs to help increase your blood pressure. You may also have an injection of immunoglobulin (a protein that helps fight infection) but this isn't a routine treatment.

Prevention of toxic shock syndrome

There is no clear way to prevent the infection. The key advice is to look out for the symptoms and talk to a doctor straight away if you think you have TSS.

It's not exactly understood why using a tampon is linked with TSS, but tampon absorbency (the amount of menstrual blood a tampon absorbs) is thought to be a factor.

If you're a woman using tampons:

• use a tampon with the lowest absorbency suitable for your menstrual blood flow
  
• change your tampon frequently - washing your hands before and after you insert it
  
• use a sanitary towel or panty liner from time to time during your period
  
• never insert more than one tampon at one time
  
• use a sanitary towel at night instead of a tampon. If you do use a tampon at night, insert a new tampon before going to bed and remove it as soon as you wake up

Once you have had TSS you can get it again. Women who have had TSS are advised not to wear a tampon or use an internal barrier contraceptive such as a diaphragm or cap.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.