[Question #1920] HIV risk surface of muslimshower/bidet spray in toilet for both male and female

45 months ago
Dear dr hook I need assurance  because of your  experience regarding  HIV risk which has no information on the internet . I am “blank” . My risk to me and wife is usage of Muslim shower /hand held bidet spray which is attached next to the  toilet seat  .  It is a replacement  toilet paper for cleaning anus ,penis and vagina once a person has done using the toilet

The link is below bidet spray so that you know what message I'm conveying 


My worry is for me and wife in public restrooms . The Muslim shower /hand held bidet can sometimes get menstrual blood on them if females are using them once they are done spraying water 

Q) if  the surface of the Muslim shower /hand held bidet where the water will spray out from  is contaminated with HIV  can it HIV live on it ? 

Q2) the most logic and easy answer is  that when  you spray water on your penis ,anus and vagina does the pressure of water coming from the Muslim shower/handheld bidet enter the blood stream every time when  me and wife spray it on our anus ,penis and vagina ? 

Q3) But anyone infected this way ? 

Q4) I spoke to my doctor he said if your spray water using the Muslim shower /hand bidet  on yourself nothing will enter your anus ,penis or vagina because they are valves which prevent from fluids entering the body . Said even if it has HIV infected blood on it and your sprayed on your private parts nothing enters and is a no risk . 

He also added that think of it as jumping in swimming pool and says water never enters the anus ,penis or vagina into the blood stream . 

Would you agree with him doctor hook ? 

Q5) I would like you to assist me by saying this is no risk for HIV or hep and nothing  can  enter the blood stream (deep into tissue )even if spraying HIV blood by using the handheld bidet/Muslim shower 
( please don't assume that how HIV blood would be on it in the first place ,and think if being sprayed with HIV blood would be no risk to private parts )

There is much information on toilet paper but zero  on my situation  doctor hook  help ? 

Thank you thank you again 

45 months ago
I meant it's a replacement "for" toilet paper in the start paragraph  sorry for that . People use toilet paper or Muslim /bidet shower spray like me and wife do 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum and thanks for your question. Users do not select the moderator who responds to their questions, and I will be answering this one, not Dr. Hook.

You are really asking the wrong questions. There have been no known HIV or viral hepatitis infections suspected to have been transmitted in toilets or by use of bidets. You're asking for the biological and anatomic reasons, but they really don't matter. This is true in settings where HIV is far more common than in most Islamic countries, where HIV remains rare. For example, no such infections among people likely to use bidets or toilets also used by commercial sex workers or gay/bi men in places like Paris, London, San Francisco, New York, or Bangkok -- and certainly no suspected cases in places like Islamabad or other Islamic countries or settings where HIV is much less common. If this has never happened, obviously there is no risk. Therefore, the answers to your specific questions don't really matter, right? (As best I can tell from the website you give, and from my own knowledge of bidets, I see no reason to suppose a higher risk from a "muslim" bidet than any other.)

I'll also add that in the earliest days of the international AIDS epidemic, no affected persons were known who had not had unsafe sex, shared drug injection equipment, blood transfusions, or other exposures to massive amounts of blood. Even before HIV was discovered, we could assure people there were no risks from other kinds of contact with other people, and no risk from sharing toilets, kitchens, etc. That remains true today. This alone means there is no risk from exposures like you have described here.

To your specific questions:

Q1) It is exceedingly unlikely that a bidet sprayer would be contaminated with enough virus to be transmitted, even if used inside the vagina (not its intended use). These viruses are rapidly killed by dilution in water; and it takes lots of virus to transmit from one person to another.

Q2) I doubt any fluid at all enters the blood stream from such devices or in showers. But it would not matter if it did.

Q3) As discussed above, nobody has ever been known or even suspected to have been infected in this way.

Q4) Your doctor probably is right. I also agree there is no risk this would happen in swimming pools, where HIV and hepatitis viruses cannot survive anyway. But as I said above, it really doesn't matter one way or the other.

Q5) I have done my best to reassure you about these things. I understand your main concern is to protect your wife from HIV and viral hepatitis. The way to do that is: 1) Vaccination against hepatitis B, which probably has been done (I believe it is normal for all people in Pakistan).  2) For neither your nor your wife to have sex outside your marriage; or, should that occur to use condoms consistently for vaginal or anal sex.  3) Do not share drug injection equipment with other people. That's all. No other protections are necessary. Certainly do not worry about water-based activities like those above.

I hope this has helped. Best wishes and stay safe.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Also see question #1899 for a more detailed discussion why environmental contamination and exposure carry no risk for HIV.

45 months ago
Dear doctor just the over all tone of the conversation has helped me forget about this encounter more or less thank you 

1)I read your blog and I have one more question on that , basically nobody has been exposed to blood once it's outside the environment on and object via cuts or nicks  and once  HIV is in liquid form it gets diluted or dies just like the exposure I am talking about  and  it can't reproduce it self . Am I right doctor ? 

So in short doctor may I just forget about this and stick to the main  point you made in last paragraph you made which gave me peace of  mind "if you don't have sex and  do drugs "No other protection is necessary 

Before you say  yes (i hope you do) and I don't think your answer will change 

2)  HIV blood can die quickly once on drying or air exposure . Can you tell me do vaginal secretion or semen(male sperm) die much quicker and becomes more non infectious earlier than HIV blood  ? 

I have one more irrational question regarding skin protection for my wife can I ask you that question if you allow me ? It is bit personal but I'll type it if you allow me and you can tell me not  to worry I hope because of the last paragraph you wrote was very helpful  I hesitated  to right it's not needed but I still want you to know about it  may I proceed ? It will be the last post so I would like you to answer heavily just like you did right now but first I need you approval to ask the question 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
I'm glad my initial comments have helped.

1) You correctly understand. In addition to dilution the the amount of virus, water disrupts the virus and kills it.

2) Drying of secretions rapidly kills HIV. There is no reason to suppose any differenence in this between blood and genital fluids.. However, I tried to emphasize that the answer to this question doesn't matter. There is no risk from contact with blood or body fluids in the environment. Whether and how fast the virus dies, and why, are not important. It doesn't happen, so why is the reason so important?

Each new question includes two follow-up comments and replies. My guess is that the answer already is obvious from my replies so far, but go ahead and ask whatever is on your mind.

45 months ago
Thank you saying whatever is in my mind before I ask the question but unfortunately I was going over the world limit so maybe a fresh post some other time would be helpful ? 

1)But before I go Just for my knowledge Urine 
and feces also do not carry HIV in them ? 

2)And nobody has been infected with HIV by coming in contact with urine or feces ? 

 3)May I just have the general view on why HIV has never been transmitted using toilets . Many people worry even getting splashes on there anus or vagina from the toilet water if it's contaminated or mixed with secretions HIV . So a general view would really help 

If I come back to you regarding my other worry is possible you will entertain the same way you have done at the moment ?  

Thank you mr hunter 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
1) Correct:  HIV typically is not present in urine and probably not in feces.

2) It's hard to know whether this has ever happened. If so, it is extremely rare and nothing that anyone should worry about.

3) Infectious diseases vary widely in ease of transmission. For measles or norovirus (the main cause of viral gastroenteritis, "stomach flu"), exposure to very few viruses floating in the air is enough. But HIV is at the other end of the spectrum. Infection is transmitted only by exposure to very large amounts of virus; and those viruses must have contact with certain types of cells that generally are deep inside the body. Even with vaginal sex, with semen loaded with HIV injected deep in the vagina, the woman is infected onlly once for ever 1.000 events. For exposure to contaminated toilets (or bidet sprayers), there simply is not enough virus and exposrue does not allow it to reach those susceptible cells deep inside the body.

Repetative and anxiety driven questions are not permitted. If your remaining quesiton has anything at all to do with HIV transmitted in any way other than sex or direct blood exposure, you should not need to ask it. To avoid HIV your entire life, have only safe sex and do not share drug injection equipment with anyone else. There are no other exposures that you need to worry about. If you have quesitons about other types of exposure, after the discussion we have had here, you should expect a very brief reply that mostly refers you back to re-read this thread. Does that make sense?

That concludes this thread. Take care and stay safe.