[Question #4305] Fish foot spa - risk?

29 months ago
Hello Dr,

I have travelled to a number of countries around the world, on various continents (Africa, the Caribbean, South America and Far East). A tourist attraction at many of these places is a fish foot spa, where tourists put their feet in water and fish nibble at dead skin on the feet - I have tried this a handful of times in various countries.

I subsequently read various media reports that these could pose a risk for Hepatitis and HIV transmission. So understandably I'm now somewhat concerned.

However despite the media reports, given how widely used these spas are by tourists from around the world, am I right to think:

1. The risk of Hepatitis B/Hepatitis C/HIV/all types of HTLV (including HTLV 1&2) would be extremely low, i.e. > 1 in 1,000?
2. And this would apply to the transmission risk for any other STDs?
3. And that the above would not change if I had any pre-existing medical condition? I've seen in other postings Von Willebrand or other types of blood clotting disorders, or bronchiectasis/Immune Thrombocytopenic purpura (ITP) mentioned. Given these are quite rare, am I right to think there is no increase in transmission risk if I had any medical condition, however rare?

Thank you in advance Dr
 







Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Welcome to our Forum.  I'll be glad to comment.  There are no well documented medical reports of complications of fish pedicures although there are studies showing that a number of non-STD bacteria (strep, atypical mycobacteria) and fungi are present both in the fish used for the pedicures and the water which is re-used.  As you might imagine, putting your feet into standing water filled with fish that other people have used before you would be expected to exposure you to whatever was on their feet.  There is no way to "sterilize" the fish since anything that would kill bacteria, viruses or fungi would also kill the fish.  While there are NO credible reports of HIV, hepatitis, or HTLV infections acquired from fish pedicures (they are typically listed as "potential problems" in the media reports and on the internet) and if you have had fish pedicures, this is not something I would worry about, it is also not something that I am anxious to have.  Fish pedicures are specifically recommended against for persons who are immunosuppressed and susceptible to infections in general. 

1. The risk of Hepatitis B/Hepatitis C/HIV/all types of HTLV (including HTLV 1&2) would be extremely low, i.e. > 1 in 1,000?
Correct. Certainly the risk is far lower than 1 in 1000 which is the risk of unprotected sexual intercourse with an infected partner.  1 in hundreds of thousands or even millions sounds like a better ball park regarding risk.

2. And this would apply to the transmission risk for any other STDs?
Yes

3. And that the above would not change if I had any pre-existing medical condition? I've seen in other postings Von Willebrand or other types of blood clotting disorders, or bronchiectasis/Immune Thrombocytopenic purpura (ITP) mentioned. Given these are quite rare, am I right to think there is no increase in transmission risk if I had any medical condition, however rare?
Rarity is not the issue.  If you are particularly vulnerable to infections, i.e. on cancer chemotherapy or immunosuppressive medications,  I would stay out of these.  OTOH, specific conditions like past ITP, clotting disorders, and bronchiectasis are NOT risk factors for HIV, HTLV or similar illnesses.  EWH
---
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
In reviewing past questions I not the similarity of these questions to those from user raybradley.  Are you that person?  We can check.  EWH
---
29 months ago
Dr,

Yes I am a friend of the user raybradley, sorry I should’ve perhaps mentioned that in my initial question. But I’ve been travelling with him and so have similar concerns (he mentioned it to me and we both have medical conditions/concerned minds!)

I think your answer covered everything, so the only follow-up I had was on your point around immunosuppressive medication - would that include people on oral/inhaled steroid medication for asthma/Bronchiectasis etc? And is the issue that IF they got the infection, it would be worse? Rather than the immunosuppressives actually increasing the risk of infection itself?

And I didn’t mention Syphillis but I’m guessing this is covered under your mention of any other STDs?

Thanks Dr, sorry for not being clear.





Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
I can only assume, given the similarity that you are the same person. I find that irritating and inappropriate.  My comments above hold for all STIs, including syphilis.  If there are other questions of this sort, please re-ready my earlier responses to raybradley.  This will end this thread.  Please, no more questions of this sort, no matter what name you use.  EWH
---
29 months ago
Thanks Dr - but sorry I wasn’t clear if you clarified on my last question around your comment on immunosuppressive drugs, does this include oral steroids/inhaled steroids for asthma/Bronchiectasis? And do you mean immunosuppressives just making the infection worse (if caught) rather than increasing any risk?

Sorry for the confusions Dr - I’m not the same person but I can understand your irritation, apologies.


29 months ago
Sorry Dr my only questions were to clarify on answers you’ve already given:

1. When you mention immunosuppressives, this does not include oral/inhaled steroids? And immunosuppressives would only make infection worse, not increase risk of transmission?
2. When you say “past ITP” in your first response, this would include instances where someone had ITP/other conditions at the time of using the foot spa?

Thank you Dr, that is all I have. If you could please just answer this I will ask nothing further - I promise.


Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
I'm sorry, I do not believe the you are not the same person.  The questions are too similar

1. When you mention immunosuppressives, this does not include oral/inhaled steroids? And immunosuppressives would only make infection worse, not increase risk of transmission?
It does not include inhaled steroids.  Oral steroids are thought to modestly increase susceptibility to some infectious diseases but this increase is NOT describe for HIV, HTLV or any of the topics included in your earlier questions.

2. When you say “past ITP” in your first response, this would include instances where someone had ITP/other conditions at the time of using the foot spa?
Yes.

End of thread.  EWH
---