Since the 1980s, there has been a steep increase in the reported cases of RWIs due in part to pollution, growing populations around bodies of water, and even climate change. Anyone involved in recreational water activities should be aware of the risk.
This article explains the causes and symptoms of recreational water illness, as well as how the infections are treated and prevented.
Common Symptoms
The symptoms of RWIs can vary by the disease-causing organism (referred to as a pathogen) and how the pathogen enters the body.
Some of the more common symptoms of RWIs include:
Diarrhea: Diarrhea is usually caused by swallowing unclean or contaminated water. It can be caused by parasites such as Giardia and Cryptosporidium, bacteria like Shigella and Escherichia coli (E. coli), and viruses like norovirus. Flu-like symptoms: Fever, chills, and body aches are common with many waterborne pathogens. These include parasitic infections like amoebiasis and cyclosporiasis as well as bacterial infections caused by Campylobacter jejuni, Salmonella typhi (typhoid fever), or Vibrio cholerae (cholera). Rash: Hot tub folliculitis is a skin infection caused by bacteria called Pseudomonas aeruginosa. The bacteria thrive in warm water and can cause raised, red, and itchy rash, mainly on uncovered skin. Ear pain: Pseudomonas aeruginosa can also cause swimmer’s ear, an infection of the outer ear canal which can cause ear swelling, redness, itchiness, and drainage. Neurologic symptoms: Certain waterborne pathogens can make their way to the brain causing symptoms like headache, light sensitivity, stiff neck, confusion, and seizure. Causes include amoebiasis and a bacteria called Leptospira.
How Recreational Water Illnesses Are Contracted
RWIs occur when you accidentally swallow or inhale contaminated water or get contaminated water into your ears or nostrils. The waterborne pathogen can also sometimes enter the body through cuts or sores or through prolonged exposure to the skin.
Contaminated water can be found in oceans, mountain streams, lakes, hot tubs, public pools, and water parks. Some pathogens are hardier than others and may not be easily killed by chlorine. Others thrive in higher water temperatures.
The source of contamination and route of infection can vary by the pathogen type.
Treatment
The treatment of RWIs can vary on whether the pathogen is a bacteria, virus, or parasite. To ensure the correct treatment, the healthcare provider may need to perform tests to help narrow the possible causes.
Bacterial RWIs can be treated with antibiotics, while parasitic RWIs may be treated with a combination of antiparasitic drugs and antibiotics. Others (like norovirus) will go away on their own and only require supportive care to reduce diarrhea or prevent dehydration.
Swimmer’s ear can be treated with antibiotic ear drops or acetic acid ear drops.
Prevention
Prevention is important to decrease the number of other people who get RWIs in addition to your chances of getting one.
Some RWIs, like swimmer’s ear and hot tub folliculitis, are easier to prevent than others. Others require concerted measures to reduce your risk, including the use of vaccines to prevent tropical diseases like cholera and typhoid fever.
There are everyday practices that can help you avoid RWIs:
Shower with soap before and after swimming, and practice good hand hygiene. Check and maintain proper chlorine levels in swimming pools and hot tubs. Don’t go swimming when you or a family member has diarrhea. Wait two weeks before swimming after you’ve had a diarrhea-causing illness. Take your children regularly to the bathroom when using recreational water facilities. Children who are not potty trained should wear a certified swim diaper plus plastic pants. Don’t swallow pool water or drink untreated natural water such as a lake or stream. Don’t get into a swimming pool or hot tub if you have open cuts or sores. Dry your ears out well or wear earplugs to keep your ears dry while showering or swimming.
If you think you have gotten sick from swimming, see a healthcare provider as soon as possible.
Summary
Recreational water illnesses (RWIs) are more common today than in previous years, caused by bacteria, parasites, viruses, and other pathogens that thrive in water. Symptoms include diarrhea, fever, skin rashes, earache, and breathing problems.
If you experience symptoms like these after swimming in a natural or man-made body of water, see a healthcare provider for the proper diagnosis and treatment.
A Word From Verywell
If traveling to a foreign country, check for local health advisories at the Traveler’s Health website managed by the Center for Disease Control and Prevention (CDC).
Based on the country you are going to, you may need to be vaccinated or provided prophylaxis (preventive) medications to avoid waterborne, mosquito-borne, or foodborne infections weeks in advance of your departure.
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