Check out this answer from Consensus:
While TSS is a rare condition, it can be associated with the use of menstrual cups. Awareness and proper hygiene practices are crucial in preventing this potentially life-threatening condition. Further research is needed to fully understand the mechanisms and risk factors associated with menstrual cup-related TSS.
Toxic Shock Syndrome (TSS) is a rare but serious condition caused by bacterial toxins. It has been historically associated with tampon use, but recent cases have shown that menstrual cups can also be a potential cause. This article explores the relationship between menstrual cup use and TSS, supported by various research findings.
What is Toxic Shock Syndrome?
TSS is an inflammatory response syndrome caused by toxigenic strains of Staphylococcus aureus or group A β-haemolytic Streptococcus. It can lead to severe symptoms such as fever, rash, hypotension, and multiorgan failure1 4 6.
Menstrual Cups and TSS
Case Reports
Several case reports have documented instances of TSS associated with menstrual cup use. For example, one study reported a rare case of menstrual TSS in a woman using a menstrual cup, confirmed by the presence of Staphylococcus aureus and TSS toxin 1 (TSST-1)1. Another case involved a 30-year-old Filipino woman who developed TSS from a menstrual cup, confirmed by methicillin-resistant Staphylococcus aureus2. These cases highlight that while rare, menstrual cups can indeed be a cause of TSS.
Mechanisms
The mechanisms by which menstrual cups may lead to TSS are similar to those associated with tampons. The prolonged use of menstrual cups can create an environment conducive to bacterial growth, leading to the production of toxins that trigger TSS3 4.
Risk Factors
Bacterial Colonization
The primary risk factor for TSS is the colonization of the vagina by Staphylococcus aureus, which produces TSST-1. This toxin activates the immune system, leading to the severe symptoms associated with TSS4 7.
Menstrual Hygiene Products
Historically, high-absorbency tampons have been the most significant risk factor for TSS. However, menstrual cups, which are used as alternatives to tampons, have also been implicated in rare cases5 6.
Management and Prevention
Prompt Diagnosis and Treatment
Early recognition and treatment of TSS are crucial. Antibiotics and supportive care are the mainstays of treatment. In some cases, prophylactic antibiotic therapy may be used to reduce the risk of recurrence1 2.
Awareness and Education
Raising awareness about the potential risks associated with menstrual cup use is essential. Educating women on the proper use and hygiene of menstrual cups can help mitigate the risk of TSS2 8.
Can you get toxic shock syndrome from a menstrual cup?
Gerard Lina has answered Near Certain
An expert from Hospices Civils de Lyon in Microbiology
One case was published in Canada in 2015 (Mitchell M, Bisch S, Arntfield S, Hosseini-Moghaddam S. 2015. A confirmed case of toxic shock syndrome associated with the use of a menstrual cup. Can. J. Infect. Dis. Med. Microbiol. 26:218-220.) and three cases spontaneously notified to the French National Center for Staphylococcal Diseases from 2016.
Can you get toxic shock syndrome from a menstrual cup?
Deborah Bateson has answered Extremely Unlikely
An expert from University of Sydney in Women’s Health, Sexual Health
Toxic shock syndrome (TSS) is a very rare condition affecting less than 1 in a million people and while it is possible to get TSS during use of a menstrual cup a recent review published in The Lancet found that only 5 cases have been reported worldwide.
TSS can affect children, men and women of all ages but it has most notably been associated with the use of tampons during menstruation. The syndrome is associated with an overwhelming immune response by the body to toxic shock toxin (TTN) which is produced in large amounts by the bacteria Staphylococcus aureus (commonly known as Golden Staph) and Group A Streptococcus. These bacteria are commonly found on the skin, nose and throat and generally do no harm but certain circumstances can allow them to overgrow and release large amounts of their toxin. The first signs of TTS can include a sun-burn like rash, reddened throat and peeling skin on the palms and soles of the feet but this can be rapidly followed in a matter of hours by a dangerous drop in blood pressure and multi-organ failure. In the 1980s a spike of over 800 TSS cases in the United States were linked to the use of super-absorbent synthetic tampons during menstruation which provided an ideal environment for bacteria to flourish. These tampons were quickly removed from the market and the number of cases of TSS dramatically reduced.
Menstrual cups are increasingly popular across the globe as an environmentally-friendly alternative to tampons and pads. A recent review of all available evidence in relation to menstrual cups published in The Lancet found there was no cause for concern with their use and that the risk of TSS is low. A study in Kenya found no difference in the rates of Staphylococcus aureus in vaginal samples between young women using a menstrual cup and those using pads and that none were positive for the toxic shock syndrome toxin-1 (TSST-1).
While one of the TSS cases was reported in a woman using a cup continuously for several days there is no clear evidence of an association with duration of use. As for tampons, it is important to use trusted brands and to follow the manufacturer’s instructions on hygienic use and care. Menstrual cups can be used for up to 12 consecutive hours depending on the heaviness of the flow. Hand washing before and after insertion and removal is essential and the cup should be emptied, washed and rinsed a minimum of 2 to 3 times in each 24-hour period. Having a second cup available may make this process easier although this comes at an additional cost. Menstrual cups should only be used during menstruation and should be stored in a clean dry container between use.
In summary, TSS is a very rare condition and while it can occur during use of a menstrual cup the risk is extremely low. It is essential to always handle menstrual cups hygienically and to follow the manufacturer’s instructions on their use.
Can you get toxic shock syndrome from a menstrual cup?
Patrick Schlievert has answered Extremely Unlikely
An expert from University of Iowa in Microbiology
There have only been 1 or 2 cases reported. 5% of women with menstrual TSS have never used tampons or other devices except pads. Thus, those rare cases in cups are likely to be coincidental not causal.