Staphylococcal toxic shock People at highest risk of staphylococcal TSS are Women who have preexisting staphylococcal colonization of the vagina and who leave tampons or other devices (eg, menstrual cups, cervical caps, intrauterine devices, contraceptive sponges, diaphragms, pessaries) in the vagina Mechanical or chemical factors related to tampon use probably enhance production of the exotoxin or facilitate its entry into the bloodstream through a mucosal break or via the uterus.