What causes toxic shock syndrome?

It can develop in connection with an infected wound, burn, recent surgery or childbirth. Menstrual tampons, menstrual cups, contraceptive diaphragms and caps may also create conditions in which toxin-producing bacteria grow, particularly if they remain in place longer than directed. The product itself does not directly poison the body.

The bacteria involved are commonly Staphylococcus aureus or group A Streptococcus. They may live on the skin or in the nose without causing illness. Trouble starts when they enter damaged tissue, multiply and release toxins. Those toxins can cause inflammation throughout the body, low blood pressure and organ injury.

Having a tampon in place is not proof of toxic shock syndrome, and the condition can occur without menstrual products. A clinician considers the rapid pattern of illness, examines for an infection source and uses blood or other samples to guide treatment.

If symptoms begin while you are using a tampon, cup, diaphragm or cap, remove it promptly and do not insert another one. Seek urgent medical assessment rather than waiting to see whether the symptoms settle. Tell the clinician about menstrual products, recent childbirth or surgery, and any wound, boil, burn or skin infection.

Hospital care may include antibiotics, fluids through a vein, support for blood pressure or breathing, and treatment of the infection source. Antibiotic choice for this emergency is made by the hospital team; it is different from routine outpatient treatment for many pelvic infections.

Get emergency help for sudden fever or chills with vomiting, diarrhoea, severe muscle pain, dizziness, fainting, confusion, breathing difficulty or a widespread rough rash. Pale, blue or blotchy skin, a rash that does not fade under pressure, or rapidly worsening illness also needs immediate attention. Do not drive yourself if you feel faint, confused or severely unwell.

Ask where the infection may have started, whether a wound needs drainage or cleaning, and how long antibiotic treatment is expected to continue. Before leaving hospital, clarify how to care for the affected area, which returning symptoms are urgent, and whether you should avoid tampons, cups, diaphragms or caps in future.