Toxic Shock Syndrome

What Increases Your Risk

Some people may be naturally more susceptible to toxic shock syndrome (TSS) than others, even in the absence of risk factors. These people lack specific antibodies against the toxins of strep or staph. People with immune system problems, such as diabetes, cancer, or autoimmune diseases, are also at higher risk for toxic shock syndrome because they are also more likely to lack the specific immune system response needed to fight the toxins.

Risk factors for menstrual TSS

The prolonged use of a tampon, especially the superabsorbent type, increases a woman's risk for menstrual TSS. If you have had menstrual TSS in the past, you have an increased risk of developing it again.

Risk factors for strep nonmenstrual TSS

Chickenpox is the most important risk factor for a strep bacterial infection leading to TSS in children.² Scratching chickenpox blisters can lead to group A streptococcal skin infections, increasing a child's risk of developing TSS.

In adults, risk factors include:

• Recent childbirth. A woman who is pregnant or has recently given birth has a greater risk of developing strep TSS, especially if one of her children has strep throat. Any pregnant woman or new mother with a child who shows signs of strep throat should talk to her gynecologist or obstetrician.
• Recent surgical abortion.
• Skin injury, including cuts, burns, deep bruises, insect and animal bites, sores caused by chickenpox or shingles, mastitis, boils, piercings, and tattoos.
• Influenza.
• Infections in the muscles, such as myositis, or in joints, such as bursitis.
• Recent respiratory infections, such as sinusitis, sore throat (pharyngitis), laryngitis, tonsillitis, or pneumonia.

Risk factors for staph nonmenstrual TSS

The risk for staph nonmenstrual TSS is increased by:

• Use of contraceptive sponges, diaphragms, or an intrauterine device (IUD).
• Skin injury, including surgical wounds, especially surgery on the nose when packing bandages are used.
• Abscesses.
• Recent respiratory infections, such as sinusitis, sore throat (pharyngitis), laryngitis, tonsillitis, or pneumonia.
• History of staph menstrual TSS.

Risk of recurrence

After having menstrual TSS, about 30% of women have at least one repeat episode.³ If you have just had menstrual TSS, you are most likely to have another case during your next three menstrual periods, especially if the original infecting bacteria was not eliminated by antibiotic treatment. Killing the infecting bacteria is especially important because research shows that about 66% of women do not develop antibodies after having menstrual TSS.⁴ Without antibodies, you are still vulnerable to the bacterial toxins that trigger toxic shock syndrome.

If you have had TSS related to tampon use, you can reduce your chances of getting it again by taking a few simple precautions. For more information, see the Prevention section of this topic.

People who have had nonmenstrual TSS are at increased risk of getting it again, although recurrence is rare.⁴

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Author:	Maria G. Essig, MS, ELS	Last Updated: March 3, 2008
Medical Review:	Anne C. Poinier, MD - Internal Medicine Dennis L. Stevens, MD, PhD - Internal Medicine, Infectious Diseases
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