Toxic Shock Syndrome

Condition 101

What is the definition of Toxic Shock Syndrome?

Toxic shock syndrome is a serious disease that involves fever, shock, and problems with several body organs.

What are the alternative names for Toxic Shock Syndrome?

Staphylococcal toxic shock syndrome; Toxic shock-like syndrome; TSLS

What are the causes for Toxic Shock Syndrome?

Toxic shock syndrome is caused by a toxin produced by some types of staphylococcus bacteria. A similar problem, called toxic shock-like syndrome (TSLS), can be caused by toxin from streptococcal bacteria. Not all staph or strep infections cause toxic shock syndrome.

The earliest cases of toxic shock syndrome involved women who used tampons during their menstrual periods. However, today less than one half of cases are linked to tampon use. Toxic shock syndrome can also occur with skin infections, burns, and after surgery. The condition can also affect children, postmenopausal women, and men.

Risk factors include:

  • Recent childbirth
  • Infection with Staphylococcus aureus (S aureus), commonly called a Staph infection
  • Foreign bodies or packings (such as those used to stop nosebleeds) inside the body
  • Menstrual period
  • Recent surgery
  • Tampon use (with higher risk if you leave one in for a long time)
  • Wound infection after surgery

What are the symptoms for Toxic Shock Syndrome?

Symptoms include:

  • Confusion
  • Diarrhea
  • General ill feeling
  • Headaches
  • High fever, sometimes accompanied by chills
  • Low blood pressure
  • Muscle aches
  • Nausea and vomiting
  • Organ failure (most often kidneys and liver)
  • Redness of eyes, mouth, throat
  • Seizures
  • Widespread red rash that looks like a sunburn -- skin peeling occurs 1 or 2 weeks after the rash, particularly on the palms of the hand or bottom of the feet

What are the current treatments for Toxic Shock Syndrome?

Treatment includes:

  • Removal of materials, such as tampons, vaginal sponges, or nasal packing
  • Drainage of infection sites (such as a surgical wound)

The goal of treatment is to maintain important body functions. This may include:

  • Antibiotics for any infection (may be given through an IV)
  • Dialysis (if severe kidney problems are present)
  • Fluids through a vein (IV)
  • Medicines to control blood pressure
  • Intravenous gamma globulin in severe cases
  • Staying in the hospital intensive care unit (ICU) for monitoring

What is the outlook (prognosis) for Toxic Shock Syndrome?

Toxic shock syndrome may be deadly in up to 50% of cases. The condition may return in those who survive.

What are the possible complications for Toxic Shock Syndrome?

Complications may include:

  • Organ damage including kidney, heart, and liver failure
  • Shock
  • Death

When should I contact a medical professional for Toxic Shock Syndrome?

Toxic shock syndrome is a medical emergency. Seek medical help right away if you develop a rash, fever, and feel ill, particularly during menstruation and tampon use or if you have had recent surgery.

How do I prevent Toxic Shock Syndrome?

You can lower your risk for menstrual toxic shock syndrome by:

  • Avoiding highly absorbent tampons
  • Changing tampons frequently (at least every 8 hours)
  • Only using tampons once in awhile during menstruation


Gardella C, Eckert LO, Lentz GM. Genital tract infections: vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In:  Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 23.

Larioza J, Brown RB. Toxic shock syndrome. In: Kellerman RD, Bope ET, eds. Conn's Current Therapy 2018. Philadelphia, PA: Elsevier Saunders; 2018;624-628.

Que Y-A, Moreillon P. Staphylococcus aureus (including Staphylococcal toxic shock syndrome). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 196.

Latest Research

Latest Advance
  • Condition: Toxic Shock Syndrome Following COVID-19 Infection
  • Journal: American journal of ophthalmology case reports
  • Treatment Used: Corticosteroid Eye Drops
  • Number of Patients: 1
  • Published —
This article examined the case of a patient with toxic shock syndrome (serious but uncommon bacterial infection) following COVID-19 (a pandemic infection caused by a coronavirus) infection treated with corticosteroid eye drops (used to prevent permanent damage to the eye).
Latest Advance
  • Condition: Severe S. Aureus Infection
  • Journal: Nature microbiology
  • Treatment Used: Bacteriophage Therapy
  • Number of Patients: 13
  • Published —
This study evaluated the safety and tolerability of using a good manufacturing practice-quality preparation of three myoviridae bacteriophages as adjunctive therapy for severe S. aureus infections.
Latest Advance
  • Condition: Septic Shock
  • Journal: Critical care (London, England)
  • Treatment Used: Very Early Start of Norepinephrine
  • Number of Patients: 337
  • Published —
This study evaluated the effectiveness of a very early start of norepinephrine in patients with septic shock (condition that occurs when sepsis, a potentially life-threatening condition caused by the body's response to an infection, leads to dangerously low blood pressure).
Latest Advance
  • Condition: Acute Necrotizing Fasciitis Complicated with Multiple Organ Dysfunction
  • Journal: Zhonghua wei zhong bing ji jiu yi xue
  • Treatment Used: Aggressive Incision and Drainage, Antibiotics, and Active Organ Support
  • Number of Patients: 1
  • Published —
This case report discusses a 50-year-old man with acute necrotizing fasciitis complicated with multiple organ dysfunction treated with surgical debridement and amputation of his right lower extremity, multiple antimicrobials combination therapy, gamma globulin-assisted anti-infection, anti-shock, bedside continuous hemofiltration, and other comprehensive treatment.

Clinical Trials

Clinical Trial
  • Status: Recruiting
  • Study Type: Device
  • Participants: 80
  • Start Date: June 6, 2020
Relation Between Mean Arterial Pressure and Renal Resistive Index in the Early Phase of Septic Shock
Clinical Trial
  • Status: Recruiting
  • Study Type: Drug
  • Participants: 130
  • Start Date: April 3, 2020
Terlipressin Versus Placebo for Septic Shock Refractory to High Doses Catecholamine Vasopressors: A Randomized-controlled Trial
Clinical Trial
  • Status: Recruiting
  • Study Type: Device
  • Participants: 32
  • Start Date: January 1, 2020
Effect of the CytoSorb Adsorber on Hemodynamic, Immunological and Pharmacokinetic Parameters in Refractory Septic Shock