Staphylococcal and streptococcal toxic shock syndromes were first described approximately 20 and 10 years ago, respectively. The incidence of the former declined markedly after having peaked in 1980, whereas the latter has assumed increasing importance during the last decade coincident with an apparent resurgence of severe disease due to Streptococcus pyogenes. Although exotoxins acting as super-antigens are recognized mediators in the pathogenesis of toxic shock syndromes, recent studies confirmed the importance of other factors linked to the bacteria, the environment, and the host. Despite better awareness and ongoing progress in intensive care medicine, the mortality rate of streptococcal toxic shock syndrome is still unacceptably high. Even in the absence of a randomized controlled trial, a consensus seems to be emerging to support the use of intravenous antibiotics that suppress toxin production together with polyspecific immunoglobulin for treatment of this disease.