Toxins released by particular strains of extremely common families of bacteria called Staphylococcus, Streptococcus,and Clostridium cause TSS. These bacteria are everywhere, including on our mucous membranes such as the throat, mouth, nose, and vagina. Most strains are harmless, but some bacteria release a threatening toxin (poison) into the blood.
Sepsis is a body-wide response to infection caused by bacteria or other substances. Septic shock is a serious case of sepsis, where the body goes into shock (life-threatening low blood pressure). TSS is a special form of septic shock caused by the toxins of the Staphylococcus and Streptococcus bacteria.
Toxic shock syndrome can occur when women use tampons, especially "super-absorbent" ones. Toxic shock sprang to public attention in 1980, when over 700 women were infected around North America. Most of these women had recently switched to a new super-absorbent tampon. It's still not clear why this type of tampon increases the risk of TSS, but it may be related to a "drying" of the vagina. Women who leave a diaphragm in place for more than 24 hours are also at an increased risk of TSS.
Many cases of TSS aren't related to tampon use, but occur after surgery, accidental injury, or childbirth. Cases due to Streptococcus usually arise following surgery, but sometimes infections of the skin can result in TSS. Cases due to Clostridium more commonly occur after childbirth and medical abortions. Staphylococcus is generally responsible in tampon-related cases.