Signs and Symptoms of Toxic Shock Syndrome
Medically reviewed by Josephine Hessert, DO
Toxic shock syndrome (TSS) is a rare but serious, life-threatening condition that occurs when bacteria like Staphylococcus aureus (known as staph) or Streptococcus pyogenes (known as strep A) release harmful toxins into the blood. If you develop this infection, it's common to experience flu-like symptoms like high fever, sore throat, and fatigue. But without treatment, symptoms can worsen and cause seizures and organ failure.
While TSS is more common in those assigned female at birth, the condition can affect any gender or age. You may be at an increased risk of developing the infection if you had surgery, have open skin wounds, are on dialysis, use tampons or nasal bandages, or experienced miscarriage, abortion, or childbirth recently.
TSS and Tampon Use
In the past, the majority of TSS cases were caused by tampon use. But, in the 1990s, manufacturers started making tampons that were less absorbent of menstrual blood, which decreased the risk of developing TSS. Today, less than half of all TSS cases are due to tampons. However, using tampons is still a risk factor for TSS. To reduce your risk, consider the following tips:
Only use tampons when you are on your period
Do not wear tampons longer than eight hours at a time
Avoid using tampons overnight
Never reuse a tampon
TSS affects less than 1% of people in the U.S. each year, but if you or a loved one experiences symptoms of the condition, it's necessary to see a healthcare provider urgently to prevent serious complications.
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Flu-Like Symptoms
When your immune system fights off harmful invaders (like bacteria, viruses, or toxins), your body's natural response is to start feeling a little sick. This reaction happens because your body becomes inflamed when your immune system is responding to a threat. If you develop TSS, it's common to experience flu-like symptoms before your condition worsens. Early symptoms of TSS may include:
Fever higher than 102 degrees Fahrenheit or 38.9 degrees Celcius
Muscle aches or weakness
Sore throat or cough
Nausea or vomiting
These TSS symptoms come suddenly and can worsen within a matter of 24 to 48 hours. If proper rest and drinking more water aren't improving your symptoms or you notice that your illness may be getting worse, it's important to see a healthcare provider for a proper diagnosis.
Low Blood Pressure
Low blood pressure—clinically known as hypotension—occurs when your blood flows through your blood vessels at a lower-than-normal pressure for your body to function properly. You may have hypotension if your blood pressure (BP) reading shows a BP of 90/60 mmHg (millimeters of mercury) or below.
With TSS, the drop in BP happens fairly quickly. This symptom occurs because toxins from TSS can cause your blood vessels to widen and make them "leaky." When your blood vessels open up too much, it allows fluid to escape from your bloodstream and into your body's tissues. The loss of fluid can reduce the amount of blood that is circulating in your vessels, which can lead to a drop in blood pressure.
Hypotension is the first major sign of a medical emergency. If your blood pressure stays too low for too long, your vital organs won’t get enough blood and oxygen to function.
Skin Rash
It’s important to note that not everyone with TSS gets a skin rash. But if your rash occurs alongside symptoms like fever and low blood pressure, this could be a sign of TSS.
When toxins from TSS widen the blood vessels in the skin, a flat, red, sunburn-like rash can appear. This rash often begins on the palms of the hands and soles of the feet before moving to other parts of your body. When you press on this rash, the redness will temporarily fade or turn pale. Within a couple of weeks, the skin will eventually dry out and start peeling.
Inflammation and Redness
Aside from a skin rash, TSS can cause also cause redness in the whites of the eyes, mouth, throat, or vagina. It's common to experience redness because TSS toxins cause inflammation and irritate the mucous membranes in your body. As a result of the inflammation, you'll likely also experience swelling and discomfort.
Some people with TSS might also experience a symptom called strawberry tongue. TSS can cause redness and swelling on your tongue. As a result, your taste buds may become bigger than normal, giving your tongue a bumpy appearance that mimics the look of a strawberry.
Confusion
Confusion occurs when you don’t know where you are, who you are, or what time it is. Some people also call this disorientation or an altered mental state. This is a severe symptom that suggests that toxins from TSS are affecting your neurological (brain) function.
Seizures
Seizures are sudden, uncontrolled disturbances that can affect the chemicals in your brain. They can cause muscle contractions, loss of consciousness, convulsions (shaking), behavioral changes, and confusion. Having a seizure is a severe symptom of TSS and requires immediate medical attention. Similar to confusion, a seizure indicates that the infection is spreading to the neurological system and affecting your brain and nerves.
Organ Dysfunction
Organ dysfunction is a severe and potentially life-threatening complication of TSS. It occurs when bacterial toxins from TSS disrupt the normal function of organs like the kidneys, liver, heart, or lungs. While this is not an exhaustive list, changes in the functioning of your organs can result in the following symptoms:
Not urinating (peeing) as often as you used to
Having too much waste or toxins in your blood
Jaundice, or the yellowing of your eyes and skin
Abnormal results on kidney and liver function tests
Low blood platelets (blood cells that help with clotting and wound healing)
Difficult breathing
When to Contact a Healthcare Provider
Contact a healthcare provider if you have flu-like symptoms that don’t go away or get worse quickly. If your flu-like symptoms persist and you begin to notice symptoms like a rash, redness, low blood pressure, confusion, and seizures, it's necessary to get the medical care you need immediately.
In some cases, especially if you recently experienced surgery, childbirth, miscarriage, or abortion, pus coming out of a wound or surgical site or unusual vaginal discharge can also be a sign of TSS. To prevent the risk of serious complications, check in with your provider to learn why pus or discharge may be occurring and to get the appropriate treatment to stop these symptoms.
If your provider suspects that you have TSS, they'll get you started on the diagnostic and treatment process as soon as possible. TSS typically requires hospitalization in an intensive care unit (ICU) and treatment such as intravenous (IV) antibiotics and fluids.
A Quick Review
It's a misconception that toxic shock syndrome (TSS) is a condition that only affects people assigned female at birth. This common myth started when tampons were the cause of the majority of TSS cases in the 1970s. But now, factors like surgery and open wounds can also increase your risk of this bacterial infection and affect anyone—regardless of sex and age.
Keep in mind: TSS is a rare, but serious medical emergency. Early signs of TSS include flu-like symptoms such as fatigue, fever, or muscle aches. But within 48 hours, TSS can cause a skin rash, low blood pressure, confusion, or seizures. Without treatment, TSS can lead to organ dysfunction and failure, which can often be life-threatening. If you or a loved one have any of these symptoms, it's in your best interest to see a healthcare provider immediately for support.
Frequently Asked Questions
How long does it take for toxic shock symptoms to develop?
Toxic shock syndrome (TSS) symptoms can develop quickly, often within a few hours or days after exposure to certain bacteria. The initial flu-like symptoms, such as high fever and muscle aches, are sudden and persistent. But, these symptoms can quickly worsen and become severe over the next day or two.
What are the beginning stages of toxic shock syndrome?
The beginning stages of toxic shock syndrome (TSS) involve a sudden onset of flu-like symptoms, including a high fever, headache, muscle aches, sore throat, fatigue, nausea, vomiting, and diarrhea.
Do symptoms of toxic shock syndrome go away on their own?
No, toxic shock syndrome (TSS) symptoms do not go away on their own. It is a medical emergency as it can worsen and become life-threatening quickly without treatment. Treatment typically involves hospitalization in an intensive care unit (ICU).
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