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Gauff vomitted  on court at one stage during the second-round contest, but ultimately prevailed 4-6 7-5 6-1 to book her place in the Round of 16.

A topsy-turvy opening set saw the duo exchange two breaks apiece before Cirstea got the better of Gauff's serve for the third time.

The vulnerability on serve continued into the second set, with six breaks traded evenly. At 4-4, Gauff then had to take a medical timeout due to illness.

However, she recovered her composure to break and take the set, before cruising to victory in the decider.

"Honestly, I was just trying to finish the match and one point turned into another," Gauff said.

"I think I've got what everybody else is having here in Madrid, unfortunately. Just going to try to push through."

Iga Swiatek was forced to withdraw from the tournament through illness 24 hours earlier.

Gauff will take on Linda Noskova in the next round.