Coco Gauff battled sickness as she dug deep to come from a set and a break down and beat Sorana Cirstea to reach the last 16 of the Madrid Open.

Despite struggling with a stomach virus that saw the American third seed vomit into a bin midway through the second set, Gauff fought back to claim a 4-6 7-5 6-1 victory.

Several players have been struggling with illness in Madrid this week, including six-time Grand Slam winner Iga Swiatek, who said she had “zero stability and zero energy” after retiring from her match against Ann Li on Saturday.

Marin Cilic withdrew before his second-round tie with Joao Fonseca on Friday, while Liudmila Samsonova also dropped out of the tournament because of illness before her third-round match with Linda Noskova.

Gauff asked for a medical timeout in the second set against Romanian 25th seed Cirstea, and when asked how she got through the match, she responded: “I don’t know honestly.”

She added: “I think I got what everybody else is having here in Madrid, unfortunately. So, I’m just going to try to push through for tomorrow.

“I did start to feel better, not feeling like I had to throw up. They gave me some pills, so that definitely helped.

“But I was really tired… The first part was literally just trying to keep whatever I ate down. Once they gave me something to help with that, then I was just nauseous and tired. But I can deal with that.”

Gauff will play Czech 13th seed Noskova in the last 16 as she continues her preparation on clay before next month’s French Open, where she is the reigning champion.

Gauff’s win over Cirstea means she has reached the fourth round in Madrid for the third straight year.

Last year she was beaten in the final by world number one Aryna Sabalenka before avenging that defeat a month later in the final at Roland Garros.