We decided to investigate whether public toilets, which are commonly believed to be a breeding ground for various pathogens, including sexually transmitted diseases, actually harbor such concerns.
Infection mode is a crucial characteristic that distinguishes infections, which can be classified as either natural or artificial. Artificial transmission routes include transfusion and injection, as well as transmission during medical procedures. Since medical procedures and injections are not typically performed in public toilets (with the exception of injection drug users), we will focus on natural transmission modes. These modes are classified as perinatal, vertical, and horizontal. Perinatal transmission occurs during birth, where the mother transmits the infection to the newborn while passing through the birth canal. Vertical transmission, also known as transplacental transmission, occurs during pregnancy when the mother passes the infection to the fetus. This mode also includes transmission through breastfeeding. Neither mode involves a carrier of the infection other than the mother. As a result, only horizontal modes of transmission remain, which can be further divided into five types:
- Transmissive
- Airborne droplet
- Fecal-oral
- Hematogenous
- Contact
Let us examine each transmission mode in more detail, starting with the transmissive route. This mode occurs when a pathogen enters the body through the bite of an insect or animal. Examples of diseases transmitted in this way include malaria, dengue fever, chikungunya, Zika virus disease, West Nile fever, and Japanese encephalitis, with mosquitoes being the carriers in all cases. Ticks, on the other hand, are carriers of tick-borne encephalitis. However, the risk of being bitten by an insect that is a carrier of a disease is about the same whether sitting on a public toilet or at a café table. Therefore, there is no need to worry about contracting diseases such as malaria while using a public restroom.
The second transmission route is through the air and droplets. This mode is responsible for the spread of acute respiratory viral infections, flu, COVID-19, chickenpox, scarlet fever, meningococcal infection, and others. The likelihood of contracting respiratory viral diseases transmitted through the air and droplets does not depend on the location but rather the number of people and the distance between them. For instance, the flu virus spreads easily up to a distance of 1 meter when an infected person coughs or sneezes. The chickenpox virus is even more “long-range” as it can spread up to 20 meters from an infected person. In this case, a separate stall in a public restroom may be safer than a bus where passengers are not separated from one another by partitions.
The third class of diseases is those primarily transmitted via the fecal-oral route, in which the infectious agent mainly resides in the gastrointestinal tract, excreted into the external environment with feces, and then penetrates a new organism through the mouth. There are three types of fecal-oral transmission routes: waterborne (for instance, accidentally swallowing water while swimming in a water body infected with enterovirus infection), alimentary (such as consuming food contaminated with Salmonella bacteria leading to salmonellosis), and contact-household (which is particularly common in children, like when licking toys or sucking fingers). Because pathogens are excreted in feces, their concentration in a public restroom may be higher than in other places. That is why we are all taught from childhood to wash our hands thoroughly after using the restroom, especially in public restrooms. Nonetheless, sitting on a public toilet seat itself does not increase the risk of infection since the pathogen must enter the mouth to infect the body. Thus, as long as you do not lick the public toilet seat and thoroughly wash your hands, the risk of contracting an infection with fecal-oral transmission in a public restroom is almost the same as in other public spaces.
The fourth mode of transmission is hematogenous, which involves contact with the blood of an infected person. Infections such as HIV, hepatitis B, and C can be transmitted hematogenously. To become infected, the infected person’s blood must enter the new host’s body through damaged skin and mucous membranes. It is important to remember that HIV is transmitted hematogenously only in the presence of skin damage; touching the blood of an infected person with undamaged skin carries no risk. Transmission can also occur through the use of a non-disposable syringe between injection drug users. Although there are no scientific facts that hematogenous infections can be transmitted through a toilet seat, it is still better not to sit on a toilet seat covered in blood. There have also been no cases of hepatitis B or C transmission through a toilet seat.
It is important to note that the risk of contracting an infection through contact transmission in a public restroom is no higher than in any other public space, as long as basic hygiene practices are followed. This includes washing hands thoroughly with soap and water, avoiding touching the face and mouth, and using a barrier (such as toilet paper or a seat cover) when using a public toilet. In addition, public restrooms are typically cleaned and disinfected regularly, which further reduces the risk of infection transmission. It is important to remember that the best way to prevent the spread of infections is to practice good hygiene habits at all times, not just in public restrooms.
However, not everything appears as frightening as it seems since scabies transmits through “skin-to-skin” contact for a prolonged time (15-20 minutes) and hardly through shared objects. In 1940, scientists conducted an experiment in the UK, where 272 volunteers slept in a bed previously used by an infected person, resulting in only four of them getting infected. Although it is possible to transmit scabies through shared objects, including toilet seats, scientists confirm the risk is extremely unlikely. Pediculosis also has a similar story as lice, carriers of the disease, do not live on toilet seats. To transmit pediculosis, it requires prolonged contact with the patient or using shared items for hair care, hats, and underwear. The risk of contracting fungal infections from toilet seats is also insignificant. In general, fungi spores can be present on any object, such as clothing, soft furniture, door handles, etc. They often spread in pools, gyms, saunas, and beauty salons. It is also almost impossible to contract genital herpes through shared objects except for shared sex toys since the virus quickly dies in the external environment.
The possibility of contracting venereal diseases through a toilet seat is also similar to that of HIV, which is not transmitted through any object, including a toilet seat. Therefore, it is entirely safe to use a stall previously used by an HIV-positive person, and even share dishes with them. Other STIs are also not transmitted through a toilet seat, and as the President of the American Society for Microbiology, Abigail Salyers, humorously remarks, “As far as I know, no one has ever contracted an STI from a toilet seat unless they had sex there.” It is theoretically possible to contract an infection if you have a wound on your buttocks and it contacts a dirty toilet seat. However, it is simply a myth to imagine that you can get syphilis, gonorrhea, and chlamydia just by sitting on a toilet seat.
Filtrated, a sports equipment analysis company, reports that when individuals use free weights in a public gym, they come into contact with a significantly higher number of bacteria, which is 362 times greater than what they encounter when sitting on a public toilet.
Doctors caution that some people avoid touching a public toilet seat by “hovering” over it due to fear of getting infected, which is an extremely unhealthy approach. The muscular tension caused by this position can lead to incomplete bladder emptying, resulting in an increase in the frequency and urgency of urination, and potentially causing prolapse or bulging of the pelvic floor organs.
Surprisingly, the toilet seat is often not the most contaminated area of the toilet. When flushed with the lid open, microbes can spread and settle around other areas such as the floor, doors, handles, and paper holders. To minimize exposure to these harmful microbes, it is recommended to flush the toilet only with the lid closed. If the lid is not available, one should leave the stall immediately after pressing the flush button to avoid contact with the aerosolized droplets that may have been released during the flushing process.
In summary, a public toilet seat can be considered safe as it is highly unlikely to contract STIs or viral hepatitis through it. One can easily protect themselves against various intestinal infections by washing their hands after using the restroom. The risk of contracting a respiratory infection from someone sneezing in the toilet is about the same as any other public place. Hovering over the toilet seat can have adverse anatomical effects and lead to unpleasant health consequences. As long as the seat is clean and dry, it is safe to sit on a public toilet seat.
Responses