Nonmenstrual toxic shock syndrome. Methodologic problems in estimating incidence and delineating risk factors.

Toxic shock syndrome (TSS) gained notoriety through its association with menstruation and tampon use. Most studies conducted in the past did not systematically ascertain the incidence of nonmenstrual TSS but relied on voluntarily reported cases, which may be biased. Moreover, some factors that influence the recognition of TSS in menstruating and nonmenstruating women may distort the risk factor status of recognized cases. For these reasons, reliable information on nonmenstrual TSS is largely unavailable.