TSS: What You Need to Know, and How to Prevent It

Let's address the elephant in the room. Fear of Toxic Shock Syndrome (TSS) is ingrained into every adolescent with a period from the time they're first introduced to tampons. So much so that our hearts skip a beat when we've realized we've had our tampon in a bit too long, or forgotten to change our menstrual cup past the 12-hour mark.

Yet, most of us don't know anyone who has been affected by TSS. The truth is, it's extremely rare. In fact, statistically speaking, it is so rare that the incidence of TSS is 0.03-0.50 cases per 100,000 menstruators.1 So, how does it happen?

To answer that question, we set out to scour the world of gynecology and found an infectious disease expert who graciously allowed us to access her expertise. Here's what we've learned so far.

What Causes TSS?

TSS is caused by two specific strains of bacteria, Staphylococcus Aureus (staph), and in some cases, Group A Streptococci (strep). Staph lives naturally on 30-50% of healthy adults, but more specifically, only about 10-20% of menstruators worldwide have a strain of staph in their vagina. Further, of the 10-20% of the menstruating population who carry staph vaginally, only 10-20% of those carry the strains are capable of producing the TSS-1 toxin, which is the specific toxin that causes Toxic Shock Syndrome.2 Staph and strep are generally harmless, but when the right conditions are in place, it can become a cause for serious concern.

When Does It Become a Problem? Four Main Risk Factors

First, staph or strep needs to be present in the vaginal canal. Again, only a small population has this.

Second, the pH of the vagina must be altered. Your vagina is naturally acidic and maintains a pH range of 3.8 to 4.5, a level that generally doesn't allow harmful bacteria to thrive very easily. However, blood is slightly alkaline (or basic) with a pH of 7.35-7.45. This means that when we menstruate, our menses will raise our vaginal pH closer to a neutral state, creating a more comfortable environment for bacteria to live. Lucky for us, our bodies are pretty good at keeping harmful bacteria at bay.

The third factor is oxygen. The staph bacteria requires oxygen to produce the toxin that can cause TSS, and this is where tampons, menstrual cups, and other vaginally inserted products come into play. Tampons and menstrual cups can introduce oxygen to the vaginal canal, feeding the bacteria that are present. But don't let fear get the best of you on this one! This is completely harmless unless the other three factors are present.

The fourth and most important factor is an entry point into the bloodstream, such as a sore, cut, or tear in the vaginal tissue. Even if the other three factors are in place, without a way of reaching your bloodstream, the bacteria and the toxin will not cause Toxic Shock.

How to Protect Yourself

All of this information is great, right? But however rare, we know that TSS does happen. The good news is that there are ways we can protect ourselves. We've created a handy checklist to help you understand how to properly care for your cup, as well as when you should pass up vaginally inserted products in favor of pads and period underwear.

Maintain proper cup hygiene by:

  • Boiling your cup for 4-5 minutes (no more than 7 minutes) or wiping it thoroughly with 70% Isopropyl alcohol to sanitize in between periods.
  • Washing your storage bag by throwing it in with a load of laundry.
  • Cleaning your hands thoroughly before inserting or removing your cup.
  • Rinsing and cleaning your cup with cold water and our Saalt Wash during your period.

Take a break from your menstrual cup if:

  • Your cup feels like it may be too big. Signs of this include overstretching your vaginal tissues when inserting and removing, causing tearing or bleeding unrelated to your period (Psst! Just reach out to us at sayhey@saalt.com. We'll help you find the right size!).
  • You have a scratch, sore, or cut in your vaginal tissue.
  • You have an infection such as bacterial vaginosis, a yeast infection, or an active sexually transmitted infection.

If I Do Have TSS, How Will I Know?

That's a great question! If you experience the following symptoms that you feel are unusual while using a menstrual cup, seek medical care immediately. Symptoms include:

  • A sudden high fever
  • Muscle aches
  • A rash resembling a sunburn, particularly on your palm and soles
  • Low blood pressure
  • Vomiting or diarrhea
  • Seizures
  • Confusion
  • Severe pelvic or abdominal pain

At Saalt, we believe that knowledge is power, and knowing how to prevent TSS is equally as important as knowing the signs and symptoms. Your period is part of your life, but with the right information, fear of TSS doesn't have to be.

If you're the type that loves to geek out over the research, check out the articles below to learn more!

Additional resources:

  1. https://mbio.asm.org/content/mbio/10/2/e00214-19.full.pdf
  2. https://aem.asm.org/content/aem/84/12/e00351-18.full.pdf
  3. https://link.springer.com/article/10.1007%2Fs10096-019-03685-x
  4. https://www.thelancet.com/action/showPdf?pii=S2468-2667%2819%2930111-2
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142822/pdf/nihms829081.pdf