Table 2: Toxic Shock Syndrome: Clinical Settings 1

Menstrual TSS

1) Tampon-associated 2
2) Not tampon-associated

Non-Menstrual TSS

1) TSS Related to the Female Genitourinary Tract

  • associated with barrier contraceptive use (diaphragm, contraceptive sponge)
  • occurring in the puerperium
  • following nonobstetric gynaecological surgery
  • associated with septic abortion

2) TSS Related to Skin or Soft Tissue Infections

  • primary staphylococcal infections (folliculitis, cellulitis, carbuncle, muscle abscess)
  • staphylococcal superinfections of preexisting lesions (burns, insect bites, varicella/zoster infections, surgical wounds) 3

3) TSS Related to Respiratory Tract Infections

  • upper respiratory tract focus (sinusitis, pharyngitis, laryngotracheitis, odontogenic infection)
  • lower respiratory tract focus (staphylococcal pneumonia)

4) TSS Related to Skeletal Infections

  • osteomyelitis
  • septic arthritis

1 Menstrual and nonmenstrual cases occur with approximately equal frequencies and are clinically identical. The mortality rate of nonmenstrual illness is substantially higher, likely due to delayed diagnosis of nonmenstrual cases.

2 The risk of TSS is particularly high in seronegative women with a prior history of TSS. Such women should avoid use of tampons or barrier contraceptives until such time as seroconversion is documented.

3 The time interval to onset of postoperative TSS ranges from hours to weeks after the surgical procedure. The risk of TSS is particularly great following rhinoplasty or nasal septoplasty, in which settings it has been estimated at 16.5 cases per 100,000 population at risk.