Today lets talk toilets and when I say talk toilets I really mean lets talk about Sexually Transmitted Diseases (STD's). Now I am pretty sure that when you think STD you don't immediately think about a toilet (you probably conjure up a disgusting image of an infected person's genitals... I know I do). You likely **don't want** to think about public toilets and whether or not they have organisms on them responsible for causing STD's either. However that is the topic that we are really going to discuss. I promise it won't be a super long article, but perhaps you will find it curiously interesting at least.

Today we discuss work published June 22, 2017 in the journal [PeerJ tiled "Primary health clinic toilet/bathroom
surface swab sampling can indicate community profile of sexually transmitted infections."](https://peerj.com/articles/3487.pdf)

<center> ![](https://steemitimages.com/DQmWHao7GLMXeyGgpfhZwXP9JhU9mpmNNH6ynP989yiq2yA/image.png)</center>
<center>[Image Source](https://c1.staticflickr.com/1/27/66303086_d2970d0ef8_b.jpg)</center>

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Microbiome analysis is a useful technique and I have been discussing things in relation to the microbiome for quite a while now so you should likely be getting a bit familiar with the concept. Briefly our [microbiome](http://learn.genetics.utah.edu/content/microbiome/) represents the collection of all microorganisms (bacteira, viruses, parasites, what ever) that live in our bodies. I often talk about the relationship of this microbiome on our personal health, however there is a different subset of research going on looking at the type of bacteria we leave behind in our environment. What you may be interested to learn is that research indicates that for areas we live in and frequent, the microbiome present on surfaces is very heavily related to our own microbiomes. [[2](http://science.sciencemag.org/content/345/6200/1048)]

To scientists interested in public health, this is an especially important finding. It indicates that studying the microbiome of surfaces could tell valuable information, with regards to what organisms a population of people generally have inside them. There has been recent work looking into whether or not public restrooms were a hotbed for STD's, and how likely you are to get infected by one [[3](https://well.blogs.nytimes.com/2015/06/08/ask-well-what-diseases-can-i-get-from-a-toilet-seat/?mcubz=1)], [[4](https://academic.oup.com/jpids/article-lookup/doi/10.1093/jpids/pit085)]. 

<center>https://media.giphy.com/media/WwgJuEWGUByZq/giphy.gif</center>
<center>"Said The Toilet"</center>

The researchers in the article we discuss today were taking a bit of a different angle and asking, 'Just how representative are STD's present in public health clinic restrooms, to those possessed by the general population surrounding said clinic?'

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# What Did The Researchers Do?

They took swabs from bathrooms and then looked at what sorts of STD's were recovered. They looked at two "sexual health" clinics from an urban area, two primary health clinics from small towns, and four primary health clinics from "remote indigenous" areas. So they had a pretty good sample of where a variety of different groups of people would live, from city dwellers to rural folk. 

### They didn't just sample each site once either!
They visited and took samples **10 separate times** at each site over a period of one year. They swabbed the **toilets, floors, sinks, walls and door handles**. 

They then correlated the microbiome data that they determined from these swabs, with the reported STD diagnoses from people in the area and wanted to see if the relative amounts of the STDs in their microbiome samples matched up well with the prevalence of diseases that the people actually had.

# Lets See Some Results

<center>![](https://steemitimages.com/DQmRSryk9eQ4LjX9Gz3RY2cvWQYrao48mPsh8YbzEkwbk1s/image.png)</center>
<center>[Figure 1A](https://peerj.com/articles/3487/)</center>

So here we are looking at how well some samples correlated for a rural area. On the Y axis is the prevalence they determined for their swabs and on the X axis is the prevalence reported from actual STD diagnoses in those clinics.  The points on the plot are labeled with two sets of letters the first of which is in reference to the disease (‘‘C’’: C. trachomatis ([chlamidya](https://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm)); ‘‘G’’: N. gonorrhoeae ([gonorrhoeae](https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm)); ‘‘T’’: T. vaginalis ([Trichomoniasis](https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm)). While the second set of letters refers to the location of the clinic (and isn't important for this blog). We can see that the correlation is surprisingly pretty good (but not perfect!)


<center>![](https://steemitimages.com/DQmdgV8sffkDJoAN6Z7RN3DdiQtP9TTDL9ymYLCDy4YwzX2/image.png)</center>
<center>[Figure 1D](https://peerj.com/articles/3487/)</center>

Here is the cumulative data both small town and very rural sites tested, the diseases and such aren't labeled but the trend is pretty clear. Using Microbiome samples obtained from swabbing surfaces in the bathrooms of health clinics to get a picture of the STDs present in a given community, correlates pretty well (for those curious, for this overall data they report a p value <0.0024 for the correlation).

# The picture is not always perfect however

What about the data from the urban site?

<center>![](https://steemitimages.com/DQmR8ujQKuqYuGb4Vfc225fAfeajDsP7ZneSeWqUUFeT6vL/image.png)</center>
<center>[Figure 1C](https://peerj.com/articles/3487/)</center>

It doesn't look too good, however this is likely more due to the fact that only 10 out of their 140 swabs came back positive for anything and these swabs were overwhelmingly positive for gonorrhea. As you can see, this data does not at all match up with the reported data from the clinic.

# Conclusions

With large enough sample sizes, researchers are able to get a pretty accurate picture of STD prevalence in a given community just from swabbing the bathrooms at health clinics. However if the swabs are not very good, then the data is also not useful, so very large numbers of swabs would need to be collected to ensure that a statistically relevant bacterial population can be measured.

# Other Conclusions

Public bathrooms at health clinics sure have a lot of gonorrhea and chlamydia in them. This really gives me the heebe jeebes and makes me wish that people spent more time cleaning these bathrooms to minimize the potential spread of diseases just from contact. 



# Sources

1) https://peerj.com/articles/3487.pdf
2) http://science.sciencemag.org/content/345/6200/1048
3) https://well.blogs.nytimes.com/2015/06/08/ask-well-what-diseases-can-i-get-from-a-toilet-seat/?mcubz=1
4) https://academic.oup.com/jpids/article-lookup/doi/10.1093/jpids/pit085


**All Non Cited Images Are From Pixabay.com or Flickr.com And Are Available Under Creative Commons Licenses**

**Any Gifs Are From Giphy.com and Are Also Available for Use Under Creative Commons Licences**

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If you like this work, please consider giving me a follow: @justtryme90. I am here to help spread scientific knowledge and break down primary publications in such a way so as to cut through the jargon and provide you the main conclusions in short (well compared to the original articles at least!) and easy to read posts.