You Can Still Get Toxic Shock Syndrome From Tampons. Here’s How to Avoid It.
While TSS is commonly associated with ultra-absorbent tampons from decades past, doctors have recently seen a concerning spike in cases.
There are few things as viscerally unsettling as realizing your body might be quietly turning against you—especially in response to something as mundane, marketed, and widely used as a tampon.
If you’re a person who uses tampons, you’ve probably heard of the dangers of toxic shock syndrome (TSS) and how it can potentially result in amputation or even death. You may even associate TSS — a life-threatening complication of certain types of bacterial infections — with the late 1970s or early 1980s when highly absorbent tampons were introduced to the market. During that time, the Centers for Disease Control and Prevention disclosed that 890 cases of TSS were reported of which 91% were associated with menstruation. The outbreak — linked to a specific tampon brand and its materials — resulted in highly absorbent tampons being taken off the market once news made waves, and eventually menstruators were warned about potential risks of using tampons. But, while rare, TSS is still happening to tampon users.
The image of it — a bacterial infection spiraling into fever, organ failure, and in extreme cases, death — lives in the cultural imagination as something both antiquated and strangely ever-present, a cautionary tale passed between mothers and daughters, whispered between the lines of tampon instructions no one really reads. But while the headlines faded, the risk never fully disappeared.
Today, in the Philippines, where conversations about menstrual health are still shaped by shame and silence, the symptoms of TSS may go unnoticed, or worse, unreported. “You may get TSS from other forms like skin wounds or recent surgery,” says Dr. Martha Muñoz, MD. “So treatment depends on how you acquire it. For TSS due to retained tampons, removal is a must, followed by irrigation of potentially colonized sites like the vagina. Hospitalization, fluid resuscitation, and empiric antibiotics are crucial. Suspected patients should be treated intensively.”
In early 2022, the Wisconsin Department of Health Services reported seeing their largest spike in TSS cases in over 10 years. Although that spike only included five instances, some high-profile TSS cases have also been making headlines: In September, influencer Kelsey Foster said she nearly died from it after she left a tampon inside of her for what she assumes was about six weeks.
Sadie Kirdar, a student in New York City, learned about TSS after nearly succumbing to sepsis which was caused by the infection. In August 2022, Kirdar was leaving summer camp with friends and camp staff, traveling on a flight from Maine back home to New York when her TSS symptoms began. She felt overheated, nauseous and faint, but chalked it up to being dehydrated since she pulled an all-nighter the night before and skipped breakfast the morning of the flight. Her plane had a detour landing in Connecticut and after sitting on the tarmac for a while, she began to feel even more faint. She and a friend begged a flight attendant for air and were let out onto stairs attached to the plane. Fifteen minutes later, her friend — who also was feeling unwell — vomited and felt better after leaving the plane. Kirdar vomited as well, but her symptoms worsened.
Shortly after, she collapsed on a chair inside of the hangar on the tarmac and was shaken awake by her counselor. She vomited more, couldn’t keep down liquids and went in and out of consciousness. “I was suddenly unresponsive…it felt like my life kept flickering before my eyes,” Kirdar tells Allure. Kirdar was taken in an ambulance to Connecticut Children’s hospital, while going in and out of consciousness the entire ride. “I’d wake up and have to vomit, and then my blood pressure would drop and I would nod out again. I remember asking, over and over, whether I was going to be okay. But all I could hear was a long beeping noise that wouldn’t go away and someone saying, ‘we’re going to try our best’.”
Before her plane took off, Kirdar inserted a super tampon from a popular brand. When she exited the plane, about three hours later, she mustered enough energy to change the tampon. Kirdar says she didn’t know much about TSS at the time. “We didn’t cover it in my health class at school. I had just turned 15 years old so I had not been to the gynecologist yet,” Kirdar says. “The only thing that I had been told from my mother was not to use a single tampon for more than six to eight hours and to not sleep with a tampon.”
Five days later, after four IVs, multiple medications, and oxygen tubes, Kirdar was diagnosed with TSS. Doctors suspected she had the infection but needed tests to confirm it as they were skeptical since she wasn’t using tampons for long periods of time. But, leaving a tampon in for more than six to eight hours straight is just one of many ways to get TSS from tampon usage.
Meet the experts:
Martha Muñoz, MD, an OBGYN who completed her residency at the Makati Medical Center.
Tiffany Pham, DO, is a board-certified obstetrician and gynecologist and medical advisor for Flo Health
Stephanie Hack, MD, a board-certified obstetrician and gynecologist and founder of the Lady Parts Doctor health platform
How do you get TSS from tampons?
Toxic Shock Syndrome is a rare but potentially life-threatening condition caused by exotoxins produced by Staphylococcus aureus or Streptococcus pyogenes, explains Dr. Muñoz. “It’s a rare but serious bacterial infection caused by leaving a tampon in for too long—typically more than eight hours,” she says. In the Philippines, she notes, the condition remains limited in part due to the more common use of disposable pads and the relatively low access to tampons.
But for those who do use tampons, particularly in contexts where education around menstrual products remains limited, the risk persists.
“TSS occurring with tampon usage is typically more common with high absorbency tampons, tampons that are left in the vagina for long periods of time, or using tampons consistently throughout your menstrual period,” says Tiffany Pham, DO, a board-certified obstetrician and gynecologist and medical advisor for Flo Health.
What are the symptoms of TSS?
While TSS symptoms vary, commonly the infection can set off a sudden high fever, chills, low blood pressure, stomach pain, nausea, headaches, vomiting, diarrhea, muscle aches, fatigue, and disorientation. Another key indicator of TSS may be a skin rash which Kirdar had, but dismissed as being nothing serious. Her doctors said it was likely her body’s first sign of infection. “I had no idea what the [TSS] symptoms were and I had no idea that the absorbency level of a tampon had anything to do with increasing one’s risk of getting TSS,” expressed Kirdar.
Dr. Pham urges patients to urgently seek medical attention if these symptoms onset rapidly — within 24-48 hours — and if they have recently used tampons, cervical caps or diaphragms.
How is TSS treated?
With prompt treatment, TSS is usually cured. Stephanie Hack, MD, a board-certified obstetrician and gynecologist and founder of the Lady Parts Doctor health platform says because of this early detection is vital. “Treatment includes hospitalization, hydration, and antibiotics with additional medications as needed, ” says Dr. Hack. “With delayed diagnosis, the mortality rate can reach up to 50%.”
Stylist and content creator Rebecca “Bex” Hyde is a survivor of TSS who had awareness of the dangers of leaving in a tampon for too long, but still used them overnight. Unlike Kirdar, Hyde had symptoms for weeks, suffering from exhaustion and an odor coming from her genitals, but assumed she was feeling unwell as a result of burnout. She visited doctors who missed her official diagnosis and prescribed her antibiotics for a bacterial infection, which eventually turned into a kidney infection. Soon, she saw a gynecologist who examined her and discovered a lodged tampon. It was estimated that the tampon was inside of her for about six weeks. Doctors told her that the antibiotics she took saved her from severe illness.
Dr. Muñoz adds that while TSS is most often associated with menstruation, it can also stem from other sources like skin wounds or recent surgeries. “Treatment depends on how you acquire it,” she explains. “For TSS due to retained tampons, removal of the tampon is a must and irrigation of potential naturally colonized sites like the vagina. Fluid resuscitation and circulatory support are done. Empiric antibiotic therapy for pending culture results is given.” Suspected patients should be hospitalized immediately and treated intensively, she emphasizes.
How to avoid getting TSS
Despite this rise in cases, toxic shock syndrome is still quite rare. It’s estimated that only 1 out of every 100,000 people get TSS. And contrary to what many people believe, only half of reported cases of TSS are associated with menstruation. Dr. Hack has thoughts around why TSS menstruation gets the most hype. “[TSS] menstrual causes account for the largest percentage of cases compared to the various non-menstrual causes,” she notes. “In addition, because most women of reproductive-age menstruate, it provides an opportunity for prevention. Lastly, I think it’s because we’ve all been told by family and friends that it’s something to be aware of.”
TSS can come from a number of ways, including from infections of surgical and burn sites to infections related to nose jobs, skin infections or even superficial breast infections. “It is also important to be aware of other objects that are used in the vagina such as cervical caps and diaphragms or menstrual cups,” says Dr. Pham. “Using these objects within their recommended time frame or practicing good hygiene techniques with these objects can help reduce your risk of TSS.”
In terms of avoiding menstruation-related TSS, prevention methods include changing your tampon at a minimum of every four to six hours, using tampons that are lower in absorbency based on your blood flow, and avoiding using tampons overnight if possible. And while it seems obvious, people should not use tampons when they aren’t menstruating. Dr. Hack adds that it’s also important for menstruators to wash their hands with soap and water prior to inserting or removing a tampon to minimize the risk of introducing harmful bacteria.
Prior to TSS, Kirdar had a normal life. “I was healthy and happy. I went to school in the Bronx and spent my summers at sleepaway camp in Maine,” she said. Now she dedicates her life to educating others on the dangers of TSS with her website Teach Schools Shock. “I want people to be aware of the causes and symptoms of TSS.”
Today, Hyde primarily wears period pants during her period. Dr. Hack verifies that opting for period pants are a safer alternative to tampons as getting TSS from pads is rare. On the occasion Hyde wears a tampon she changes them after one to two hours of use.
TSS is life changing for those who’ve survived it. If you’ve had it once, there’s an increased chance you can get the it again. For Hyde, it’s given her the gift of being more in tune with her body and aware if something feels off. “I’m careful about how I look after myself and appreciate how amazing the human body is. People have lost their legs after two weeks [from TSS] so I am incredibly lucky.”
