Toxic Shock Syndrome

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a serious bacterial infection that affects many systems of the body. Staphylococcus aureus (commonly referred to as “staph”) and Streptococcus pyogenes (usually referred to as group A Streptococcus or “strep”) are the two bacteria most often associated with toxic shock syndrome. They can release toxins into the bloodstream. These toxins can spread to many body organs, causing illness and damage.

Who gets TSS?

Staphylococcus aureus TSS

Anyone can get TSS but some factors can increase risk. Women that use tampons, contraceptive sponges, diaphragms or other devices may be at increased risk of staph TSS. The risk is much lower now than it was in the past because changes were made to make tampons safer. People with cuts, burns or other open wounds are also at increased risk.

Streptococcus pyogenes TSS

TSS from S. pyogenes is most commonly seen in children and older adults. People may be at risk if they have cuts or open wounds, have an infection of the skin, or inject illegal drugs. Other people at risk are adults 65 years and older and people with diabetes, chronic lung disease, heart disease, or those have had a recent viral infection like chickenpox or shingles.

How is TSS spread?

TSS is an uncommon and serious complication from a bacterial infection and does not spread to others. However, staph and strep infections can spread from one person to another but only rarely lead to TSS.

What are the symptoms of TSS?

Common signs and symptoms include fever, muscle aches, vomiting and diarrhea, and a sunburn-like rash that later peels. Low blood pressure, shock, multi-organ failure, and death can occur.

How soon after exposure do symptoms appear?

TSS can develop within 12 hours in some cases.

How is TSS diagnosed?

There is no single test used to diagnose TSS. TSS is usually diagnosed by a healthcare provider based on patient’s signs and symptoms of illness, and laboratory results.

What is the treatment for TSS?

TSS is treated with antibiotics and supportive care (measures to help improve the symptoms of the disease). People with TSS need care in a hospital. They often need fluids given through a vein, medicine to raise blood pressure, help with breathing, dialysis, and surgery to remove infected tissue.

Do people who have been in contact with someone with TSS infection need to be tested and treated?

People who have been in contact with someone with TSS infection from S. aureus do not need to be tested or treated. Watch for signs and symptoms of illness. Call your healthcare provider if you become sick. People that live with someone with TSS from S. pyogenes may need to take antibiotics to prevent infection. Your healthcare provider can help decide if you need antibiotics to prevent infection.

How can TSS be prevented?

Some TSS can be prevented by using the lowest absorbency tampon needed. Do not leave tampons, diaphragms, contraceptive sponges or other devices in place for too long. Follow the directions on the box. Do not use tampons if you have had tampon-related TSS in the past. TSS can also be prevented with correct wound care, covering coughs and sneezes and good hand hygiene. Finish all antibiotics prescribed by your healthcare provider.

Early recognition and treatment of staphylococcal and streptococcal infections can help prevent serious complications such as TSS.

How can I get more information about TSS?

• If you have concerns about TSS, contact your healthcare provider.
• Call your local health department. You can find your local health department at vdh.virginia.gov/health-department-locator/
• Visit the CDC page About Toxic Shock Syndrome at cdc.gov/group-a-strep/about/streptococcal-toxic-shock-syndrome.html for more information.