TSS results in high fever, rash (resembling a sunburn, with diffuse erythema followed by desquamation), vomiting, diarrhea, hypotension, and multiorgan involvement (especially Gl, renal, and/or hepatic damage). An outbreak of TSS occurred in the late 1970s among menstruating women. It was shown to be related to the use of hyperabsorbant tampons by women who happened to be vaginally colonized by toxic shock syndrome toxin-(TSST)-positive strains of S. aureus. [Note: These tampons stimulated TSST expression, resulting in entry of the toxin into the circulation in the absence of true infection.] The incidence has decreased markedly since such tampons were removed from the market. Of the few cases of TSS that occur currently, approximately half are associated with ordinary S. aureus infections. Of the remainder, many result from a circulating enterotoxin rather than TSST. Figure shows the desquamation (peeling or scaling of the skin) seen in TSS.