By Bradley Ching, Class of 2011
Faculty Peer Reviewed
What do every road trip, football game halftime, and trans-continental plane flight have in common? Usually a disgusting toilet paired with the urgent need of people to use them. While no one takes pleasure from these encounters, could they in fact be a risk for acquiring a sexually transmitted disease?
Gonorrhea or “the clap,” as it is lovingly nicknamed, is caused by the bacteria Neisseria gonorrhoeae and is most commonly transmitted via sexual intercourse. It is able to infect the non-cornified epithelium of the cervix, urethra, rectum, pharynx, and conjunctiva. There were 336,742 gonorrhea cases reported to the Centers for Disease Control in 2008, making it the second most common notifiable infectious disease after Chlamydia trachomatis infection (1.2 million cases).[1]
The idea that one can contract a sexually transmitted disease from a toilet or other fomite has been around for years and is usually dismissed as either an urban legend or the desperate excuse of an unfaithful partner. There have, however, been a few case reports of such infections taking place under special circumstances. In 1939, Dr. Leon Herman described an immobile patient with bilateral leg fractures developing a gonorrhea infection in the hospital after sharing a urinal with his infected neighbor.[2] A report from 2003 suggested that an 8-year-old girl was infected with N. gonorrhoeae during an international plane flight when she used her hand to wipe the toilet seat before urinating, possibly causing subsequent infection after cleaning herself with the same hand.[3] While these reports are sparse and neither definitively proves the mode of acquisition, they do lead one to wonder if fomite transmission really may be possible.
N. gonorrhoeae is notoriously susceptible to drying, and this is recognized as a major factor in limiting nonsexual transmission. In a study reported in the New England Journal of Medicine, Gilbaugh and Fuchs scientifically examined the possibility of transmission from a toilet seat by documenting the latency of live N. gonorrhoeae suspensions after being placed on a sterile toilet seat. During their study, the authors observed that all of the organisms in a saline suspension were nonviable shortly after the sample had dried, validating previous conceptions about the gonococci. However, organisms that were suspended in purulent discharge from donors were viable for up to two hours after seat inoculation.[4] This proved that, theoretically, gonococcus could be living on a toilet seat near you.
Even though this theoretical risk was shown, the authors were unable to isolate a single N. gonorrhoeae from 72 cultures of various public restrooms.[4] In a subsequent study, gonococci could not be recovered from 38 separate attempts of culturing a toilet in a venereal-disease treatment clinic over a six-month period,[5] leading one to believe that it is extremely unlikely that live gonococci can be found on a toilet seat.
Overall, the likelihood of gonorrhea transmission via toilet seats seems highly improbable and almost impossible when using good judgment. While toilet seats have a very small chance of having live bacteria from a previous user, there is still no mechanism for inoculation of the urethral or anal area from normal toilet usage, unless one’s hands become contaminated from pre-cleaning the seat or toilet. This author can therefore safely conclude: If the toilet looks clean and dry, just sit on it.
Bradley Ching is a 4th year medical student at NYU School of Medicine
Peer reviewed by Robert Holzman, MD, NYU School of Medicine
Image courtesy of Wikimedia Commons
References
1. CDC. Summary of Notifiable Diseases–United States, 2008. MMWR. 2010;57(54):19.
2. Herman L. The Practice of Urology. Philadelphia: WB Saunders; 1939.
3. Dayan L. Transmission of Neisseria gonorrhoeae from a toilet seat. Sex Transm Infect. 2004;80(4): 327. http://sti.bmj.com/content/80/4/327.1.full
4. Gilbaugh JH Jr, Fuchs BC. The gonococcus and the toilet seat. N Engl J Med. 1979:301(2):91-93.
5. Rein M. Nonsexual acquisition of genital gonococcal infection. N Engl J Med. 1979:301(24):1347. http://www.jstor.org/stable/30142627