Dear doctor;

Is it true that public toilets can expose one to various infections, especially STIs? Kebarungi.

Dear Kebarungi,

Some public toilets do expose one to risk of urinary tract infections, not STIs. STIs are exclusively acquired and transmitted by sexual contact only. But since the urinary and genital system are close to one another, infection of one can easily contaminate another.

The commode type of toilets where one has to sit over a seat to relieve, are the ones which carry risk of transmitting infections. This is because the seat may be contaminated by microbes left by a previous user. Women are more prone to acquire these germs. This is because of the short length of urethra (tube connecting bladder to outside) in women facilitates microbes to enter the urinary system directly. Poor  personal hygiene, damp underclothes, poor menstrual hygiene, blood flow during menses, all these factors increase the vulnerability of a woman to acquire urinary tract infections. Most common germ implicated is Escherichia coli. Other germs causing urinary infections are proteus, Kleibsella, enterococci, among others. Possibility of sickness occurring depends on load of germs and resistance of the individual. The risk is also enhanced if previous user had a bladder infection, that is to say, cystitis. If resistance is lowered due to diabetes, HIV infection, any chronic disease even small amount of microbes can cause disease. But if resistance is good, a very high load of germs would be able to make the person sick, otherwise the body will contain the infection. Once somebody is infected, there will be increased frequency of urination, painful urination, pain lower abdomen, among other symptoms. Spread of microbes to surrounding genitals and pelvic parts can cause pain lower abdomen, itching and pain over private parts, with or without discharge.

Diagnosis is made by microscopic examination of midstream sample of first urine passed in morning. Complete cure is possible by antibiotics.

The prevention lies in avoiding public toilets, unless they are clean. It is better to clean the seat with water if possible otherwise with a toilet paper before sitting on it. A wise person would also leave a clean seat to avoid contamination of any kind for another individual. Drinking adequate water, maintaining good perineal hygiene particularly during menses and after sex, helps to keep these infections away.