Streptococcal Toxic Shock Syndrome: All You Need to Know

A dialysis machine, which acts like the kidneys for someone with kidney failure

Streptococcal toxic shock syndrome (STSS) is a rare, but serious bacterial infection. STSS can develop very quickly into low blood pressure, multiple organ failure, and even death. Good wound care, hand hygiene, and cough etiquette are important for preventing this serious and often deadly disease.

Group A strep causes STSS

Bacteria called group A Streptococcus (group A strep) can cause STSS when they spread into deep tissues and the bloodstream.

Sometimes the bacteria get into the body through openings in the skin, like an injury or surgical wound. The bacteria can also get into the body through mucus membranes, like the skin inside the nose and throat. However, experts do not know how the bacteria get into the body for nearly half of people with STSS.

STSS is rarely contagious

It is very rare for someone with STSS to spread the infection to other people. However, any group A strep infection can turn into STSS and it is very easy to spread group A strep.

Learn about other group A strep infections.

Signs and symptoms

STSS often begins with the following symptoms:

  • Fever and chills
  • Muscle aches
  • Nausea and vomiting

After the first symptoms start, it usually only takes about 24 to 48 hours for low blood pressure to develop. Once this happens, STSS quickly gets much more serious:

  • Hypotension (low blood pressure)
  • Tachycardia (faster than normal heart rate)
  • Tachypnea (rapid breathing)
  • Organ failure (other signs that organs are not working)
    • Examples: Someone with kidney failure may not make urine. Someone with liver failure may bleed or bruise a lot or their skin and eyes may turn yellow.

Seek medical attention immediately if you have signs or symptoms of STSS.

Some people are at increased risk

Anyone can get STSS, but there are some factors that can increase your risk of getting this infection.

  • Age: STSS is most common in adults 65 years old or older.
  • Breaks in the skin: People with an open wound, including those who recently had surgery or a viral infection that causes open sores (such as varicella that causes chickenpox and shingles), are at increased risk for STSS.
  • Chronic illnesses: People with diabetes or alcohol use disorder, previously known as alcohol dependence or alcoholism, are at increased risk for STSS.

Many tests, considerations help doctors diagnose STSS

There is no single test used to diagnose STSS. Instead, doctors may:

  • Collect blood or other samples to test for group A strep infection
  • Order tests to see how well different organs are working

Doctors diagnose STSS when they find group A strep in a patient who also has:

  • Low blood pressure
  • Problems with two or more of the following organs:
    • Kidney
    • Liver
    • Lung
    • Blood
    • Skin
    • Soft tissue (tissue beneath the skin and muscles)

STSS needs treatment in a hospital

Doctors treat STSS with antibiotics. People with STSS need care in a hospital. They often need fluids given through a vein and other treatments to help treat shock and organ failure. Many people with STSS also need surgery to remove infected tissue.

Serious complications are common

STSS often results in complications from organs shutting down and the body going into shock, including:

  • Limbs removed through surgery
  • Severe scarring from having infected tissues removed through surgery

Even with treatment, STSS can be deadly. Out of 10 people with STSS, as many as 3 people will die from the infection.

Protect yourself and others

While there is no vaccine to prevent STSS, there are things people can do to protect themselves.

Good wound Care

Good wound care is the best way to prevent bacterial skin infections.

  • Clean all minor cuts and injuries that break the skin (like blisters and scrapes) with soap and water.
  • Clean and cover draining or open wounds with clean, dry bandages until they heal.
  • See a doctor for puncture and other deep or serious wounds.
  • If you have an open wound or active infection, avoid spending time in:
    • Hot tubs
    • Swimming pools
    • Natural bodies of water (e.g., lakes, rivers, oceans)


The best way to keep from getting or spreading group A strep is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating. To prevent group A strep infections, you should:

  • Cover your mouth and nose with a tissue when you cough or sneeze.
  • Put your used tissue in the waste basket.
  • Cough or sneeze into your upper sleeve or elbow, not your hands, if you don’t have a tissue.
  • Wash your hands often with soap and water for at least 20 seconds.
  • Use an alcohol-based hand rub if soap and water are not available.

You should also wash glasses, utensils, and plates after someone who is sick uses them. After they have been washed, these items are safe for others to use.


It is very rare for someone with STSS to spread the infection to other people. For this reason, doctors usually do not give preventive antibiotics to people who are under the age of 65 years and in close contact with someone with STSS. People who live together would be an example of close contacts. However, doctors may consider giving antibiotics to close contacts who are 65 years old or older and at higher risk of getting STSS.