Toxic shock syndrome

Toxic shock syndrome (TSS) is a rare but life-threatening condition caused by bacteria getting into the body and releasing harmful toxins.

It's often associated with tampon use in young women, but it can affect anyone of any age – including men and children.

TSS gets worse very quickly and can be fatal if not treated promptly. But if it's diagnosed and treated early on, most people will make a full recovery.

Symptoms of toxic shock syndrome

The symptoms of TSS start suddenly and get worse quickly.

Symptoms can include:

• a high temperature (fever) of 39C (102.2F) or above
• flu-like symptoms, such as a headache, chills, muscle aches, a sore throat and a cough
• feeling and being sick
• diarrhoea 
• a widespread sunburn-like rash
• the whites of the eyes, lips and tongue turning a bright red
• dizziness or fainting
• breathing difficulties
• confusion
• drowsiness

Sometimes you may also have a wound on your skin where the bacteria got into your body, but this isn't always there and it may not look infected.

When to get medical advice

TSS is a medical emergency.

While these symptoms could be due an illness other than TSS, it's important to contact your GP, local out of hours service or NHS 111 as soon as possible if you have a combination of these symptoms.

It's very unlikely that you have TSS, but these symptoms shouldn't be ignored.

Go to your nearest accident and emergency (A&E) department or call 999 for an ambulance immediately if you have severe symptoms or your symptoms are getting rapidly worse.

If you're wearing a tampon, remove it straight away. Also tell your doctor if you've been using a tampon, recently suffered a burn or skin injury, or if you have a skin infection such as a boil.

If your GP or doctor suspects you have TSS, you'll be referred to hospital immediately.

Treatment for toxic shock syndrome

If you have TSS, you'll need to be admitted to hospital and may need to be treated in an intensive care unit.

Treatment may involve:

• antibiotics to treat the infection
• in some cases, pooled immunoglobulin (purified antibodies taken out of donated blood from many people) may also be given to fight the infection
• oxygen to help with breathing
• fluids to help prevent dehydration and organ damage
• medication to help control blood pressure
• dialysis if the kidneys stop functioning
• in severe cases, surgery to remove any dead tissue – rarely, it may be necessary to amputate the affected area

Most people will start to feel better within a few days, but it may be several weeks before they're well enough to leave hospital.

Causes of toxic shock syndrome

TSS is caused by either Staphylococcus or Streptococcus bacteria.

These bacteria normally live harmlessly on the skin, nose or mouth, but if they get deeper into the body they can release toxins that damage tissue and stop organs working.

The following can increase your risk of developing TSS:

• using tampons – particularly if you leave them in for longer than recommended or you use "super-absorbent" tampons
• using female barrier contraceptives, such as a contraceptive diaphragm or contraceptive cap
• a break in your skin, such as a cut, burn, boil, insect bite or surgical wound
• childbirth
• using nasal packing to treat a nosebleed 
• having a Staphylococcal infection or Streptococcal infection, such as a throat infection, impetigo or cellulitis

TSS isn't spread from person to person. You don't develop immunity to it once you've had it, so you can get it more than once.

Preventing toxic shock syndrome

The following measures can help reduce your risk of TSS:

• treat wounds and burns quickly and get medical advice if you develop signs of an infection, such as swelling, redness and increasing pain
• always use a tampon with the lowest absorbency suitable for your menstrual flow
• alternate tampons with a sanitary towel or panty liners during your period
• wash your hands before and after inserting a tampon
• change tampons regularly – as often as directed on the pack (usually at least every four to eight hours)
• never insert more than one tampon at a time
• when using a tampon at night, insert a fresh tampon before going to bed and remove it on waking
• remove a tampon at the end of your period
• when using female barrier contraception, follow the manufacturer's instructions about how long you can leave it in

It's a good idea to avoid using tampons or female barrier contraception if you've had TSS before.