What Is Toxic Shock Syndrome (TSS)?

Toxic Shock Syndrome (TSS) is a rare but life-threatening medical condition. It is caused by toxins created by staph and strep bacterial infections. TSS is commonly linked to tampon use that has a higher absorbency level than is needed for an individual’s level of menstrual flow. However, women need to know that other risk factors play a part. Conditions like skin wounds, surgical sites and even menstrual cups—can also trigger the condition. The National Institutes of Health reports the incidence of TSS today is estimated to be less than one per 100,000 in the United States.

John Monk, MD, a board-certified OB/GYN at Franciscan Physician Network Crown Point Health Center, said, “It’s important to understand the facts on tampon safety and that TSS doesn’t only impact menstruating women, and it isn’t only caused by tampons. It can impact infants, men and post-menopausal women too.”

What Are The Symptoms Of TSS?

Toxic shock syndrome can come on suddenly and progress quickly. Dr. Monk said that early symptoms of TSS often resemble the flu, including fever, chills, nausea, body aches and vomiting.

“However, some people experience additional symptoms like low blood pressure, a rash and peeling skin on the hands and feet,” he said.

How Are Tampons, Menstrual Cups And TSS Related?

The link between tampons and toxic shock syndrome first came to light in 1980, when a surge in cases was associated with high-absorbency tampons. Since then, regulations have led to significant reductions in TSS cases.

“The Centers for Disease Control and Prevention worked with tampon manufacturers to remove the high-absorbency tampons from the market and to add warning labels encouraging consumers to use the lowest absorbency product necessary,” Dr. Monk said. “As a result, cases were significantly reduced.”

Menstrual cups have also been associated with a low risk of TSS, though less frequently than tampons. 

“Women who use menstrual cups should follow safe handling practices, including proper sterilization before each use. Whether using tampons or menstrual cups, understanding how to reduce TSS risk through safe hygiene practices is key,” Dr. Monk said.

Are Viral Myths Around TSS Trustworthy?

In today’s digital age, misinformation about health issues can spread quickly, especially on social media.

“Viral videos or posts sometimes lead to unnecessary fear or misconceptions,” Dr. Monk said. “We also know many people consult ‘Dr. Google’ when they have a medical concern. Some may receive a test result and search online to understand what it means before talking with their physician. Others may search for their symptoms attempting to diagnose a medical issue for themselves or a loved one.”

Don’t rely on internet searches or social media posts for medical advice. If you have questions about what may be causing your symptoms or about health information you’re seeing on social media, please talk with your healthcare provider.

Can Lake Swimming With A Tampon Increase TSS Risk?

Recently, a viral post circulated about a young girl who reportedly developed TSS after swimming in a lake while wearing a tampon.

“Is it possible to get TSS from swimming in a lake while wearing a tampon? Potentially, but it is no more or less inherently risky than wearing a tampon in general,” Dr. Monk said.

Do Tampons Contain Heavy Metals, And Should You Be Concerned?

Shortly after the viral post about the young girl’s lake incident went viral, researchers at UC Berkeley School of Public Health found trace quantities of 16 types of heavy metals in 14 different brands of tampons in the U.S. and the United Kingdom. Reports of the study hit mainstream media, raising new questions about the safety of tampons.

While the study found the presence of heavy metals, it didn’t show what brands they tested, whether the metals can or are being absorbed into the body, or what dangers, if any, they may pose. The study itself said, “Future research is needed to replicate our findings and determine whether metals can leach out of tampons and cross the vaginal epithelium (lining) into systemic circulation.”

Dr. Monk emphasized that “fear-mongering social media posts are intended to do just that—get clicks, likes, and shares that boost exposure for content providers.” It’s a reminder to be critical of where you get your health information.

“The bottom line is the information we have today is that tampons in and of themselves do not pose a health risk when used properly,” Dr. Monk said.

How Can You Use Tampons Safely?

To minimize the already low risk of TSS from tampon use, Dr. Monk recommended the following safety precautions:

• Avoid wearing tampons overnight or when not menstruating.
• Change tampons every 4 to 8 hours.
• Monitor for any unusual symptoms, such as fever, rash or flu-like symptoms, and seek medical attention immediately if they occur.
• Practice proper hygiene when inserting and removing tampons.
• Use the lowest absorbency tampon necessary for your flow.

How Is Toxic Shock Syndrome Treated?

Toxic shock syndrome is treated with antibiotics in a hospital setting. Dr. Monk said, “That’s why it is critical to talk to your provider right away if you have symptoms. It takes a medical professional to diagnose and treat a medical issue accurately.”