There's no denying that public bathrooms can be germ-ridden places. According to a study presented at the Infectious Diseases Society of America annual meeting, scientists who studied samples taken from a variety of public restrooms found that the sheer number of illness-causing bacteria present was too big to measure in many cases. So it's only natural to worry about what may be lurking on even the cleanest-looking toilet seats — forget about the ones that appear wet or dirty.
No wonder that 60 percent of Americans say they won’t sit down to use a public toilet, according to the Web site of Sani-Seat, a company that makes those nifty gizmos that automatically wrap the seat in a fresh plastic cover after each use.
But experts say our fear of sitting on the average toilet seat (one that isn't visibly soiled) is overblown.
There's no question that germs can inhabit the seat, says Philip Tierno, MD, director of clinical microbiology and diagnostic immunology at New York University Medical Center and Mt. Sinai Medical Center in New York City. "The bulk of the organisms found are basically fecal-borne bacteria." These nasties can include E. coli (which can cause bloody diarrhea or abdominal cramps), streptococcus (the bug behind strep throat), or S. aureus (linked to serious skin problems or pneumonia).
But just because they’re on the seat doesn't mean they’ll make you sick. That’s because your skin acts as a very effective barrier to keep germs out (unless you have an open wound or lesion on your behind).
What about the herpes virus, HIV, or other sexually transmitted diseases? These organisms don't survive for long outside the human body, especially not on a cold, hard toilet seat. And to infect you, they need to enter either through an open cut or sore or via a mucous membrane (your mouth or rectum, for example), which wouldn't normally come into contact with the seat. All this makes the odds of infection from just sitting down miniscule.
Are you safer if you use those paper seat protectors? Dr. Tierno isn't a fan: "They're too thin, they rip and fall apart." If you want to use them, he says, you can double-fold them, or place double-folded toilet paper on the seat. The automatically replaced plastic covers are better, he says, but such barriers on the seat act more as psychological than physical protection.
That said, no one wants to sit on a visibly dirty or soiled seat. Use common sense, Tierno says: "If [the toilet seat is] dirty, don't use it." But in general, he says, "You're unlikely to pick up anything from a toilet seat."
Where Germs Really Hide
But germs aren't only found on the seat itself. "Where you find the organisms in larger quantities would be the underside of the toilet seat, because that is not cleaned as often [as the top]. As you flush, you bring up the contents in the bowl," says Tierno. "It's not just your germs, it's germs from other people." Some toilets can aerosolize the contents for quite a distance after being flushed, he says: "five feet or so, with lower-volume flushes." Older toilets can spray as far as 20 feet! If you're using a public toilet that doesn't have a lid, Tierno recommends opening the door first before you flush, to get out of the way of the spray quickly.
And those far-reaching flushes may be responsible for another germ-ridden area of a typical public restroom: the floor. An ABC News investigation of the germiest spots in public bathrooms found that the floor has about 2 million bacteria per square inch! If you carry a purse or shoulder bag, avoid putting it down on the floor while you're in the bathroom — hang it on the back of the door if possible.
But the real danger in picking up and carrying around germs comes from your hands, warns Tierno: "The 10 dirtiest things are your fingers." Germs left on your hands can be easily transferred to surfaces you touch or to your eyes, mouth, or nose — where they can make you and other people sick. That's why hand-washing with lots of soap and water is so important after using the bathroom.
And we're talking especially to you, gentlemen: In a 2010 study, the American Society for Microbiology found that only 77 percent of men wash their hands before leaving the bathroom, compared with 93 percent of women.
What's the best way to scrub? The Centers for Disease Control and Prevention recommends that you rub your hands with soap lather for at least 20 seconds (the amount of time it takes to sing "Happy Birthday" twice), and be sure to scrub the backs of your hands, between your fingers, and under your nails. If soap and water is not available, Tierno says, use a quarter-sized drop of alcohol-based hand sanitizer. You can then use a paper towel to turn off the faucet and open the door to leave.
Here's the bottom line: It's not your bottom you need to worry about, it's your hands. Wash them!
Do you have a health head-scratcher? Submit it here, and we may answer your question in a future column!