Toxic shock syndrome: symptoms, causes, treatment and prevention

The NHS says toxic shock syndrome can come on quickly. The main symptoms are a high temperature or feeling hot, cold or shivery, muscle aches, a raised skin rash that feels like sandpaper, and flu-like symptoms.

Further signs that should prompt you to get help from NHS 111, according to the NHS, include vomiting and diarrhoea, severe pain in the arms or legs or all over the body, a rash that feels rough like sandpaper (it may look red, which can be harder to see on brown or black skin), the palms of the hands, soles of the feet, tongue and whites of the eyes turning bright red, swollen or peeling skin, and feeling sick, dizzy or confused.

• High temperature, or feeling hot, cold or shivery.

• Muscle aches and flu-like symptoms.

• A rash that feels like sandpaper.

• Vomiting and diarrhoea.

• Bright red palms of the hands, soles of the feet, tongue and whites of the eyes.

• Swollen or peeling skin, and feeling dizzy or confused.

The NHS describes toxic shock syndrome (TSS) as a rare but life-threatening condition caused by an infection. It says symptoms develop quickly and you need urgent treatment.

Although tampons are the best-known association, the NHS lists several other situations in which TSS can occur, including an infected cut, wound, boil or burn. That means people who do not use tampons or menstrual cups can get it too.

For adults and older children, the NHS says to call 999 or go to A&E if there is confusion, slurred speech or not making sense, blue, grey, pale or blotchy skin, lips or tongue, a rash that does not fade when you roll a glass over it, difficulty breathing or breathing very fast, or large areas of peeling skin.

For babies and young children, it lists blue, grey, pale or blotchy skin, a non-fading rash, difficulty breathing, a weak high-pitched cry, not responding as normal, not feeding, and being sleepier than normal or difficult to wake. They may not have all the symptoms. Do not drive to A&E: ask someone to drive you or call 999, and bring any medicines you take. If you are using a tampon or menstrual cup, remove it and tell NHS 111 you were using one.

The NHS says TSS is a rare infection. It is possible to get it from using tampons or menstrual cups, from a contraceptive diaphragm or cap, after a vaginal birth or caesarean section, or from a cut, wound, boil or burn that has become infected. Your chances of getting TSS are higher if you have had it before.

The NHS prevention advice is about reducing the chance of catching or spreading a bacterial infection, which is why it focuses on hand washing, not leaving products in longer than needed or recommended, and keeping cuts and burns clean.

The NHS says you need urgent hospital treatment for TSS. Treatment can include antibiotics to treat the infection, fluids to rehydrate you (usually through a drip in the arm), medicine to help control your blood pressure, oxygen, and surgery to remove infection from cuts or wounds.

The NHS page does not give a typical recovery time for TSS. For the related condition sepsis, the NHS says it can take weeks or months to recover and that some people have post-sepsis syndrome, so ask the hospital team about follow-up after any severe infection.

Toxic shock syndrome and sepsis are both medical emergencies caused by infection, and both need urgent hospital treatment. The NHS describes sepsis as a serious reaction to an infection that can be life-threatening, that develops quickly over a few hours. The features below are taken from the NHS pages for each condition.

The NHS lists specific warning signs in babies and young children: blue, grey, pale or blotchy skin, lips or tongue, a rash that does not fade when you roll a glass over it (the same as meningitis), difficulty breathing or breathing very fast, a weak high-pitched cry that is not like their normal cry, not responding as normal or not being interested in feeding, and being sleepier than normal or difficult to wake. It says they may not have all these symptoms.

Call 999 or go to A&E for any of these. Do not drive to A&E: ask someone to drive you or call 999 and ask for an ambulance, and bring any medicines you take with you.

TSS is rare, but the NHS says there are things you can do to reduce your chance of a bacterial infection.

• Wash your hands and follow the instructions when using tampons, menstrual cups, contraceptive caps and diaphragms.

• Do not leave them in longer than needed or recommended.

• Keep cuts and burns clean, and look out for signs of infection such as a rash, swelling or pain.

• If you have had TSS before, your doctor may advise you not to use tampons, contraceptive caps or diaphragms.

TSS is an emergency managed through NHS 111, ambulance services and hospital emergency departments, and the NHS says you will need urgent hospital treatment. It is not something to wait on a routine or private appointment for.

After recovery, you can ask your GP which menstrual and contraceptive products are suitable. The NHS says that if you have had TSS before, your doctor may advise you not to use tampons, contraceptive caps or diaphragms.