Toxic Shock Syndrome: What You Need to Know

TSS information

Most of us have heard of Toxic Shock Syndrome at one point or another. It’s a big, scary name for a mysterious illness that many of us don’t fully understand. Just like monsters under your bed, we believe that shining a little light on a Big Scary Thing can help make it more manageable! We believe that by knowing the facts, you can make choices (like using external menstrual products, being gentle with your body, and avoiding using high-absorbency tampons) that reduce your already low risk of experiencing TSS.

What is Toxic Shock Syndrome (TSS)?

Toxic Shock Syndrome (TSS) is an illness caused by a bacterial toxin. About half of all cases of TSS occur in menstruating women (hereafter referred to as “tampon-related” TSS, as this is the term most frequently used); the other 50% can occur in any gender or age group. Risk factors include having cuts or burns on your skin; recent surgery; using contraceptive sponges, diaphragms, or tampons, particularly for long periods of time; recent abortion or miscarriage; and having a viral infection such as chickenpox or the flu.

How common is tampon-related TSS?

Tampon-related Toxic Shock Syndrome is very rare. While it’s hard to know exactly how many cases occur each year, some estimates put it at about 3 to 4 occurrences per 100,000 tampon users in the US per year; others estimate 1 to 17 occurrences per menstruating person per year.

How serious is TSS?

Toxic Shock Syndrome is a medical emergency and can be fatal within hours of contracting the illness. Many people with TSS require hospitalization. The mortality rate for TSS if treated is about 5 to 15%, but may be higher in some regions. Once a person has been diagnosed with TSS, there is a 30 to 40% chance of recurrence.

What are the symptoms of TSS?

Unfortunately, doctors are not always trained to be on the lookout for TSS and may misinterpret symptoms as signs of another illness. It’s important to be aware of the symptoms of Toxic Shock Syndrome, particularly if any of the risk factors apply to you. Some of the symptoms of TSS are:

  • sudden fever
  • sunburn-like rash
  • low blood pressure
  • vomiting, nausea, or diarrhea
  • redness of mucous membranes (eyes, throat, or vaginal)
  • headache
  • muscle aches
  • seizures

What causes TSS?

The bacteria that cause TSS (most commonly Streptococcus pyogenes and Staphylococcus aureus) are present on the skin of approximately 15 to 40% of people, and can also be present in vaginal flora (the typical bacteria that inhabit the vagina). Because the bacterial make-up of our bodies can change over time, testing for the presence of specific bacteria is not recommended.

One leading theory about the cause of TSS is that micro abrasions are what allow the toxic shock bacteria to enter the blood stream. While it’s not currently understood what situations are most hospitable to allow for the growth of the bacteria, it has been postulated that the absorbency of tampons creates a breeding ground for the TSS bacteria.

In the wake of an epidemic of TSS cases in the 1980s related to super-absorbent tampons, reducing the length of time recommend for tampon-wearing and reducing the absorbency of tampons led to a significant decrease in reported cases of TSS. However, there has been one confirmed case of TSS following usage of a menstrual cup, which is non-absorbent. Some cases of TSS have occurred when fibers of tampons or sponges where left behind in the body, or when a tampon was left in the body for many hours (as many as 30 in one case). More research needs to be done to adequately understand the conditions which make TSS possible.

Why should we talk about TSS?

We believe that companies whose products may increase the risk of TSS have a responsibility to help educate consumers, whether by including easy to understand information with their product or by creating a larger conversation. While TSS is very rare, everyone can take simple steps to limit their risk and have the knowledge to seek medical help immediately if necessary. Breaking the taboo about menstruation is not just about reducing shame and stigma — it is about making sure everyone has the information they need to make the healthiest choice for their body and lifestyle.

Now what?

Now that you’ve got the nitty gritty on TSS and its risks, you’re probably wondering what you can do to protect yourself, aside from avoiding tampons. Because the bacteria is present on 15-40% of people’s skin already, the first and easiest step is to wash your hands thoroughly when your hands will be in contact with mucous membranes such as the vaginal area. If you use a menstrual cup, this is not a step to skip! You may not notice micro-tears or small abrasions that could allow the TSS-causing bacteria to enter the bloodstream, so always wash your hands extra well (especially under the fingernails) before removing or inserting your menstrual cup. Menstrual cups made of medical-grade silicone, such as the Moon Cup, are non-absorbent and considered inert which means that the material does not harbor bacterial growth. Simply washing your medical-grade silicone menstrual cup twice daily with body-safe soap and water is ample sanitation. Of course, you should always consult your doctor or medical care provider with specific questions or concerns about reducing your risk.

Please note that this blog post is for informational purposes and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.