# Toxic Shock Syndrome (TSS) > Toxic shock syndrome is a rare but life-threatening illness caused by toxins from certain bacteria. It is historically linked to high-absorbency tampon use, and it can come on fast with high fever, a sunburn-like rash, and a sudden drop in blood pressure. It is a medical emergency. **Type:** conditions **Categories:** tampons **Risk Level:** avoid **Evidence Strength:** strong **Status:** active **Source:** https://www.r3recs.com/learn/conditions/toxic-shock-syndrome ## Reality Check **Claim:** Organic or '100% cotton' tampons cannot cause toxic shock syndrome. **Reality:** TSS is caused by bacterial toxins, not the cotton itself, and the main drivers are absorbency and wear time. Any tampon left in too long or more absorbent than needed can raise risk. Material choice helps at the margins; absorbency and timing matter most. ## Overview Toxic shock syndrome, or TSS, is a rare but serious illness caused by toxins released by certain bacteria, most often Staphylococcus aureus and sometimes group A streptococcus. It became widely known in the late 1970s and early 1980s, when a wave of cases was traced to a specific brand of super-absorbent tampon. That product was pulled from the market, high-absorbency materials were reformulated, and menstrual TSS became much rarer. But it has not disappeared, which is why every tampon box still carries a TSS warning. ## Why tampons are part of the story TSS is not caused by tampons themselves. It is caused by bacteria producing toxins. The connection is that a high-absorbency tampon, especially one left in too long, can create conditions that let those bacteria multiply, particularly if it is more absorbent than your flow requires. The historical cases were tied to super-absorbent synthetic materials, including certain forms of [rayon](/learn/ingredients/rayon), which is part of why fiber type and absorbency matter. The single biggest lever you control is using the lowest absorbency that handles your flow and changing it on schedule. ## Warning signs (act fast) TSS comes on suddenly and progresses quickly. Per Mayo Clinic and the CDC, watch for: - A **sudden high fever** - A **rash that looks like a sunburn**, often on the palms and soles - **Vomiting or diarrhea** - **Dizziness, fainting, or a drop in blood pressure** - Muscle aches, confusion, or headache If you have these symptoms while using a tampon, **remove the tampon and seek emergency care immediately**, and tell the medical team you were using a tampon. TSS can progress to organ failure within hours, so it is not something to wait out. ## How to prevent it The prevention steps are simple and well established by the FDA, CDC, and Mayo Clinic: - Use the **lowest absorbency** that manages your flow. If you can wear a tampon for eight hours without it being saturated, you are using one that is too absorbent. - **Change tampons every 4 to 8 hours**, and never leave one in longer than 8 hours. - **Alternate** tampons with pads or period underwear, for example using pads overnight. - Wash your hands before insertion, and use the lowest absorbency for lighter days. These habits, not a specific brand, are what actually lower TSS risk. This is why R3 treats a brand offering a full range of absorbencies as a small positive: it makes it easier to match absorbency to flow, which is the core prevention step. ## Also Known As - TSS - menstrual toxic shock syndrome - staphylococcal toxic shock ## Where Found - Associated with high-absorbency tampon use - Also occurs with skin wounds, surgery, and nasal packing (non-menstrual TSS) - Can affect anyone, not only people who menstruate ## Health Concerns TSS is a rare medical emergency. Toxins from Staph or Strep bacteria trigger sudden high fever, a sunburn-like rash, low blood pressure, and can rapidly progress to organ failure and death if untreated. Menstrual cases are strongly linked to high-absorbency tampon use and prolonged wear time. ## Regulatory Status The FDA requires standardized absorbency labeling and a TSS warning on all tampon packaging, a rule that followed the early-1980s outbreak and the withdrawal of the Rely super-absorbent tampon. There is no 'TSS-free' certification; prevention rests on absorbency choice and wear-time habits. ## Label Guide **Look for:** - FDA standardized absorbency rating (Light, Regular, Super, Super Plus) - A brand offering a full absorbency range so you can size down - The TSS warning and 8-hour guidance on the box **Avoid / misleading:** - Using 'Super' or 'Super Plus' on light-flow days out of habit - Overnight tampon use beyond 8 hours - Ignoring early symptoms because TSS is 'rare' ## Look For Instead - Lowest absorbency that handles your flow - A full absorbency range so you can size down - Alternating tampons with pads overnight ## Who Is At Risk - People using tampons more absorbent than their flow requires - Anyone leaving a tampon in longer than 8 hours - Younger menstruators, who historically have had higher menstrual TSS rates - People recovering from surgery or skin wounds (non-menstrual TSS) ## Common Triggers In Products - super-absorbent tampons used on light days - tampons worn longer than 8 hours ## What Helps Use the lowest absorbency that handles your flow, change every 4 to 8 hours, never exceed 8 hours, and alternate with pads or period underwear. Know the warning signs and treat sudden fever plus rash during tampon use as an emergency. ## When To See A Doctor Seek emergency care immediately if you develop a sudden high fever, a sunburn-like rash, vomiting, dizziness, or fainting while using a tampon. Remove the tampon and tell medical staff you were using one. TSS can progress to organ failure within hours. ## How To Verify There is no product test for TSS risk. The verifiable levers are the FDA-standardized absorbency rating on the box and your own wear-time habits. ## Timeline - **1980:** Outbreak — A spike in menstrual TSS is traced to super-absorbent tampons. - **1980:** Rely withdrawn — The Rely super-absorbent tampon is pulled from the market; high-absorbency materials are reformulated. - **1982:** FDA labeling — Standardized absorbency labeling and TSS warnings become required on tampon packaging. ## Why absorbency range matters in tampon scores Matching absorbency to flow is the single biggest TSS-prevention step. R3 gives a small positive to brands that offer a full range of absorbencies, because it lets you size down on light days instead of defaulting to a too-absorbent tampon. ## What This Does Not Cover This page covers menstrual TSS related to tampon use. Non-menstrual TSS from wounds, surgery, or other sources follows similar warning signs but different prevention, and any suspected TSS requires immediate medical care. ## R3 Bottom Line - TSS is rare but a true emergency; sudden high fever plus a sunburn-like rash during tampon use means remove it and get care now. - It is caused by bacterial toxins, not the tampon material; absorbency and wear time are the main risk drivers. - Use the lowest absorbency that handles your flow, change every 4 to 8 hours, and never exceed 8 hours. - A full absorbency range makes it easier to size down, which is why R3 counts it as a small positive. ## FAQ ### What is toxic shock syndrome? TSS is a rare, life-threatening illness caused by toxins from Staphylococcus or Streptococcus bacteria. It is historically linked to high-absorbency tampon use and comes on suddenly with high fever, a sunburn-like rash, low blood pressure, and can progress to organ failure within hours. It is a medical emergency requiring immediate care. ### What are the warning signs of TSS from a tampon? Watch for a sudden high fever, a rash that looks like a sunburn (often on palms and soles), vomiting or diarrhea, dizziness or fainting, and muscle aches or confusion. If these appear while using a tampon, remove it and seek emergency care immediately, and tell the medical team you were using a tampon. ### How do I prevent toxic shock syndrome? Use the lowest absorbency that handles your flow, change tampons every 4 to 8 hours, never leave one in longer than 8 hours, and alternate with pads or period underwear. If you can wear a tampon for eight hours without it saturating, switch to a lower absorbency. ### Does tampon absorbency affect TSS risk? Yes. Higher absorbency than your flow needs is a key risk factor, which is why the early-1980s outbreak was tied to super-absorbent tampons. Matching absorbency to flow and changing on schedule is the most important prevention step, more than which brand or material you choose. ### Can organic cotton tampons cause TSS? Yes, any tampon can. TSS is caused by bacterial toxins, not by the cotton, so organic or 100% cotton tampons are not immune. The risk comes from absorbency and wear time, so the same rules apply: lowest absorbency needed, change every 4 to 8 hours. ## Sources - [Toxic shock syndrome - Symptoms & causes](https://www.mayoclinic.org/diseases-conditions/toxic-shock-syndrome/symptoms-causes/syc-20355384) — *Mayo Clinic* (2024) - [Toxic Shock Syndrome (TSS): Causes, Symptoms & Treatment](https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome) — *Cleveland Clinic* (2024) - [Toxic Shock Syndrome - StatPearls](https://www.ncbi.nlm.nih.gov/books/NBK459345/) — *NCBI / NIH* (2024) - [Device-Associated Menstrual Toxic Shock Syndrome](https://pmc.ncbi.nlm.nih.gov/articles/PMC7254860/) — *PMC / NIH* (2020) - [What is toxic shock syndrome?](https://www.poison.org/articles/toxic-shock-syndrome) — *National Capital Poison Center* (2024) - [Understanding Toxic Shock Syndrome](https://www.webmd.com/women/understanding-toxic-shock-syndrome-basics) — *WebMD* (2024) - [Tampon Safety (absorbency and TSS guidance)](https://www.center4research.org/tampon-safety/) — *National Center for Health Research* (2024) - [Toxic Shock Syndrome](https://www.nyc.gov/site/doh/health/health-topics/toxic-shock-syndrome.page) — *NYC Department of Health* (2024) --- Source: https://www.r3recs.com/learn/conditions/toxic-shock-syndrome Methodology: https://www.r3recs.com/methodology/how-we-score-products