Last reviewed: 3 Sep 2022
Last updated: 22 Apr 2022



History and exam

Key diagnostic factors

  • antecedent tetanus-prone injury
  • tetanus immunisation status
  • trismus (lock jaw)
  • back pain
  • muscle stiffness/increased tone
  • dysphagia
  • spasms
More key diagnostic factors

Other diagnostic factors

  • injecting drug habits
  • respiratory distress
  • labile blood pressure, pulse rate, and temperature
  • sweating
Other diagnostic factors

Risk factors

  • incomplete tetanus immunisation
  • injury
  • aseptic obstetric practices
  • injecting drug habits
  • asterile intramuscular injection
  • abdominal surgery
  • acupuncture, ear piercing, pedicures, toothpicks
  • necrotic tumours
  • middle ear infection
More risk factors

Diagnostic investigations

Investigations to consider

  • clinical diagnosis
  • serum toxin
  • Clostridium tetani detection from wound tissue or swab
  • serum antitoxin antibodies
  • spores on drug samples or paraphernalia
  • lumbar puncture
  • electroencephalogram (EEG)
  • electromyogram (EMG)
More investigations to consider

Treatment algorithm


clean and minor wound

tetanus-prone wound


with clinical tetanus



Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, FISTM, DCH, DTM&H

Honorary Consultant and Emeritus Professor of Tropical and Infectious Diseases

Liverpool University Hospitals NHS Foundation Trust and Liverpool School of Tropical Medicine




NJB lectures at non-commercial meetings and conferences and publishes articles in peer-reviewed publications on the topic of tetanus. He has received sponsorship from specialist societies only to attend and speak at conferences. Views expressed in this topic are those of the contributor and do not necessarily represent the official position of the National Health Service, the National Institute for Health Research, the Department of Health, or the UK Health Security Agency. NJB is an author of a number of references cited in this topic.

Christopher M. Parry, BA, MB, BCh, PhD, FRCP, FRCPath, DTMH

Consultant in Medical Microbiology

Alder Hey Children’s NHS Foundation Trust

Director of Studies for DTM&H programme & Honorary Clinical Research Fellow

Liverpool School of Tropical Medicine



Visiting Professor

School of Tropical Medicine and Global Health

Nagasaki University


Visiting Professor

Centre for Tropical Medicine and Global Health

University of Oxford




CMP is an author of a number of references cited in this topic.


Dr Nicholas J. Beeching and Dr Christopher M. Parry would like to gratefully acknowledge Dr Lucy E. Cottle and Professor Enitan D. Carrol, previous contributors to this topic.

Peer reviewers

Louise Thwaites, BSc, MBBS, MD

Senior Clinical Research Fellow

Oxford University Clinical Research Unit

Hospital for Tropical Diseases

Ho Chi Minh City


Centre for Tropical Medicine and Global Health

Oxford University

Oxford, UK


LT is an author of a number of references cited in this topic.

Katrina Kretsinger, MD, MA


U.S. Public Health Service

Medical Epidemiologist

HIV Vaccine Team

Epidemiology Branch

Division of HIV/AIDS Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention

Atlanta, GA


KK declares that she has no competing interests.

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