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Updated: Dec 5, 2025

Multiplexed Fluorescent Immunohistochemical Staining of Four Endometrial Immune Cell Types in Recurrent Miscarriage
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Menstrual Cup-Associated Toxic Shock Syndrome.

Christian Neumann1, Rene Kaiser1, Judith Bauer1

  • 1Joint Medical Service (Germany), Department of Internal Medicine, Military Hospital Ulm, Ulm, Germany.

European Journal of Case Reports in Internal Medicine
|October 21, 2020
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Toxic shock syndrome (TSS) can be linked to menstrual cup use. This rare case highlights the importance of considering TSS in menstruating individuals with specific symptoms, and prophylactic antibiotics may prevent recurrence.

Keywords:
Menstrual cupmenstrual toxic shock syndrome

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Area of Science:

  • Infectious Diseases
  • Toxicology
  • Women's Health

Background:

  • Toxic shock syndrome (TSS) is a severe, acute inflammatory condition.
  • It is typically associated with toxigenic strains of *Staphylococcus aureus* or *Streptococcus pyogenes*.
  • Menstrual hygiene practices can influence TSS risk.

Purpose of the Study:

  • To report a rare case of menstrual toxic shock syndrome.
  • To investigate the association between menstrual cup usage and TSS.
  • To evaluate the efficacy of prophylactic treatment in preventing TSS recurrence.

Main Methods:

  • Diagnosis based on established case definition criteria for TSS.
  • Identification of *Staphylococcus aureus* with TSST-1 from vaginal cultures.
  • Treatment with prompt antibiotics and supportive care.
  • Prophylactic intravaginal clindamycin administered for recurrence prevention.

Main Results:

  • A case of menstrual TSS linked to menstrual cup use was identified.
  • *Staphylococcus aureus* producing TSST-1 was confirmed.
  • The patient experienced no relapse of TSS in the 12 months following discharge after prophylactic treatment.

Conclusions:

  • TSS must be considered in menstruating females presenting with fever, rash, and hypotension.
  • Prompt antibiotic and supportive care are crucial for managing TSS.
  • Menstrual cups represent a potential, albeit rare, risk factor for TSS.
  • Prophylactic antibiotic therapy may be beneficial in reducing TSS relapse rates.