Toxic Shock Syndrome

By | June 10, 2022

Toxic shock syndrome (TSS) is also known as tampon disease. It is a dangerous infection that causes massive symptoms and can lead to organ failure and death. Fortunately, this disease is no longer common in Germany.

What is Toxic Shock Syndrome?

Toxic shock syndrome is caused by the metabolic products of dangerous strains of bacteria, streptococci and Staphylococcus aureus, which find their way into the human body in most cases by wearing a tampon for a long time, but also by suppurating wounds, insect bites or the like. For slang hepatitis a, please visit

The infection leads to a number of highly unpleasant symptoms. A high fever between 38.9 and 40 degrees occurs, as well as severe muscle pain, low blood pressure (often in connection with fainting or fainting spells ), tachycardia, hematomas, irritation of the mucous membranes (reddening) and disorientation or confusion.

In the gastrointestinal tract, the infection often manifests itself in nausea and/or vomiting, there are disorders of the liver and kidney function, and there is a widespread skin rash (the skin typically peels on the palms of the hands and soles of the feet). If the infection was caused by streptococci, breathing difficulties, necrosis and bleeding disorders may also occur.


In about fifty percent of cases, the trigger is actually a (strongly absorbent) tampon that has remained in the vagina for too long and offers the pathogens an optimal breeding ground. But purulent wounds, wearing a diaphragm for contraception, and burns and surgical wounds can also be entry points for the pathogens Staphylococcus aureus and streptococci.

The metabolic processes of these two human-oriented species of bacteria produce toxins that cause disease (hence toxic). Strep infection is slightly more dangerous, but also less common than toxic shock syndrome caused by Staphylococcus aureus.

Symptoms, Ailments & Signs

Toxic shock syndrome is characterized by a sudden onset of severe illness. Without treatment, the disease can quickly lead to death. It is striking that this syndrome occurs mainly in young and previously healthy individuals whose immune systems are intact.

However, since those affected come into contact with the bacterial toxin for the first time when the disease breaks out, the violent reactions of the body can be explained. Toxic shock syndrome is characterized by severe general symptoms, skin symptoms and, in women, often gynecological symptoms. The general symptoms observed include chills, fever, nausea, vomiting, diarrhea, dizziness, muscle pain and even circulatory collapse.

Blood pressure is very low and body temperature usually exceeds 38.9 degrees Celsius. Typical skin symptoms are large rashes and, after about one to two weeks, peeling skin on the soles of the feet and palms of the hands. Since the infections are very often triggered by tampons in the genital area, there is often inflammation of the mucous membranes in the vagina and purulent vaginal discharge.

In addition to the gastrointestinal tract, the skin and the vaginal mucosa, the liver, kidneys, blood or even the central nervous system can also be damaged. Therefore, in the course of the disease, the development of liver or kidney failure is also possible. In addition, states of confusion can occur. In particularly severe cases, life-threatening shock symptoms develop with cold sweat, cyanosis, greatly increased respiratory rate due to the lack of oxygen, an insatiable feeling of thirst and acute kidney failure.

Diagnosis & History

Many of the symptoms are similar to other infections and can initially mislead medical professionals. If people are experiencing the symptoms described above and are aware that they have been wearing a tampon for a long time or have given the bacteria a similar entry point, they should report this to their doctor immediately.

The symptoms themselves are severe and resemble those of blood poisoning. Toxic shock syndrome is clinically proven by a blood smear, in which antibodies against the bacterial toxin TSST-1 can be detected in the case of illness. If toxic shock syndrome is recognized and treated in time, there is a very good chance of a complete cure. However, if left untreated, it can also lead to organ failure or even death.

When should you go to the doctor?

The person affected is dependent on medical treatment and examination for this disease, as this is the only way to cure it. If the disease is treated late or not at all, this can lead to serious complications and, in most cases, to the death of the person affected due to organ failure. Therefore, with this disease, it is necessary to contact a doctor at the very first symptoms and signs.

The doctor should be consulted if the person concerned suffers from sudden nausea or vomiting. There is also fever and, in most cases, severe pain in the muscles. Most of those affected also have dizziness and often a loss of consciousness. Confusion or a blue discoloration of the skin and lips can also indicate this syndrome and should be examined by a doctor.

If these symptoms occur, an ambulance should be called immediately or a hospital should be visited. Further treatment is then usually inpatient. The further course depends very much on the exact symptoms and the cause of the syndrome.

Treatment & Therapy

Rapid treatment of toxic shock syndrome is urgently recommended, because those affected are doing extremely badly with the symptoms. If not treated in time, it can lead to (multiple) organ failure and even death.

Those affected must be hospitalized immediately and given an appropriate intravenous antibiotic that fights the infection and kills the bacteria. Additional supportive measures are often taken to stabilize the patient as best as possible.

This includes the supply of sufficient fluid (also intravenously) to keep the bodily functions constant and to counteract the shock. In some cases, oxygen is given or, if the kidneys are damaged, dialysis is carried out.


In Europe, after the epidemic of the 1970s, the production and storage of tampons was significantly improved from a hygienic point of view, and tampons were made (mostly) less absorbent, so that they had to be changed more frequently, which in turn reduced the risk of toxic shock syndrome.

Tampons sold in Germany must provide information about toxic shock syndrome on the packaging or in the package insert. The best prevention is actually to change tampons frequently (of course only with thoroughly washed fingers!) and sometimes, for example at night, to use pads instead. Contraceptive diaphragms should not be left in the vagina longer than necessary.

The fact that good education about toxic shock syndrome is already paying off today can also be seen from the very moderate annual infection rate – compared to the USA – which is around 1 per 200,000 people.


Toxic Shock Syndrome is a rare condition that requires consistent follow-up care. Contact persons are the gynecologist or the specialists who specialize in affected parts of the body, such as the nephrologist or internist for kidney problems or the dermatologist with regard to the frequent skin involvement. The psychologist can subsequently help those affected to mentally process the often severe clinical picture well after therapy.

Switching to a different type of menstrual hygiene than tampons is very important as part of aftercare, since tampons are a frequent trigger of TSS, which is also popularly known as tampon disease. In addition to pads, menstrual cups, which are also used by consumers who are conscious of sustainability, to avoid mountains of rubbish around menstruation, also come into question.

Toxic shock syndrome is often a burden for the entire organism. Therefore, the body should be protected and strengthened at the same time during aftercare. Sufficient sleep and a healthy diet are important factors in this context. In addition, drinking enough water helps to flush toxins out of the body and to stabilize the circulatory system in the long term.

Movement serves to regenerate the body, but should initially be done with particular care. Walks are often sufficient here. The possibly affected skin areas must initially be consistently protected from UV light, also as part of the aftercare.

You can do that yourself

Toxic shock syndrome is a serious condition that requires medical attention. Depending on the course, various self-help measures can be taken.

Affected people must take it easy and follow a suitable diet. In the first days and weeks after a hospital stay, a light diet is recommended. If fever has occurred as part of toxic shock syndrome, body temperature must be checked regularly. In case of doubt, the attending doctor must be contacted. This is particularly recommended for recurring complaints that do not subside despite rest and bed rest. With early treatment without serious complications, bed rest is enough to overcome toxic shock syndrome. If serious complications such as organ failure or high fever occur, a long recovery phase is necessary after the treatment so that the body can regenerate sufficiently.

After or during recovery, it is also important to determine and eliminate the causes of the occurrence of toxic shock syndrome. Physical hygiene needs to be improved to avoid recurrence of the disease. Women must take into account the instructions regarding the use of tampons. In general, risk factors should be minimized.

Toxic Shock Syndrome