Most of the time swimming is safe, but you can get sick from swimming in contaminated water. Recreational water illnesses (RWIs) include a variety of infections that can affect many different organ systems in the body. Since the 1990's, there has been an increase in RWIs; with water-related illnesses on the rise, comes an increased need for awareness among swimmers and other people involved in recreational water use.
What Are the Most Common Symptoms of Recreational Water Illnesses?
- Diarrhea: The most common RWI symptom is diarrhea. Diarrhea can be caused by cryptosporidium (commonly known as "crypto") and escherichia coli (E. coli).
- Hot Tub Rash or Dermatitis: These rashes are usually raised, red and itchy. The most severely affected areas are often those that were not covered by a bathing suit. The most common germ that causes a hot tub rash is pseudomonas aeruginosa.
- Ear Pain: Pseudomonas aeruginosa can also cause swimmer's ear (otitis externa). Swimmer's ear can occur in adults and children, but is more common in children. Along with ear pain, other common symptoms include inflammation (redness), itchiness inside the ear canal and ear drainage.
How Are Recreational Water Illnesses Contracted?RWIs happen when you accidentally swallow, inhale or get water that contains certain germs in your ears. It may possibly also occur through cuts or open sores. Contaminated water can be found in mountain streams and lakes, hot tubs, public pools or water parks, oceans - just about any recreational source of water you can identify.
One thing that is important to understand is that chlorine does not immediately kill RWI germs. Once the water source is contaminated, it can take chlorine minutes or even days to kill the contaminant. Even a little contact with the germ can cause you to become sick. The most common populations at risk for contracting an RWI are children, pregnant women and people with compromised immune systems, such as transplant recipients and those who have HIV or who have undergone chemotherapy.
RWIs are not spread from person to person through direct contact, such as physical touch, kissing or most sexual contact. It is not possible, for example, to give swimmer's ear to someone else. Diarrhea-causing parasites can be spread through fecal matter (if you don't wash your hands after using the restroom and then eat, for example). Rashes acquired in hot tubs and swimming pools are generally not contagious. However, if you have diarrhea and then get in a swimming pool you will contaminate the water, making it much more likely that someone else will develop an RWI.
Some illnesses such as methicillin-resistant Staphylococcus aureus (MRSA) do not live long in chlorinated water and are more likely to be passed from person to person through indirect contact, such as using the same towel or by touching other shared objects. This doesn't really count as a true RWI.
How Are RWIs Treated?Some recreational water illnesses can be treated with antibiotics or anti-fungal medications, while others will go away on their own and only require symptom management to provide comfort or prevent dehydration. Swimmer's ear is treated with antibiotic drops that must be put inside the ear. Seeking medical attention at the onset of symptoms can ensure that you receive the proper medical treatment for your illness and avoid serious complications. The length of the infection will vary by the germ causing it and whether or not antibiotics or anti-fungal medications can be used.
How Can I Prevent Recreational Water Illnesses?Prevention is very important. With the exception of swimmer's ear, which is easier to prevent (read: How to Prevent Swimmer's Ear) than some of the other RWIs, you may not always have the ability to prevent acquiring an RWI. You should, however, do all you can to prevent spreading these infections, which will decrease the incidence of RWIs and subsequently your chances of getting one. Listed below are some generalized prevention techniques:
- Shower (preferably with soap) before and after swimming, and practice good hand hygiene.
- Check and maintain proper chlorine levels in personal swimming pools and hot tubs.
- Don't go swimming when you or a family member has diarrhea. Most pools recommend waiting 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 (e.g., stream water).
- 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 suspect you have gotten sick from swimming see a medical professional as soon as possible.
CDC. 2010. Cryptosporidium ("Crypto"). Accessed: August 14, 2011 from http://www.cdc.gov/healthywater/swimming/rwi/illnesses/cryptosporidium.html
CDC. 2011. Recreational Water Illnesses (RWIs). Accessed: August 14, 2011 from http://www.cdc.gov/healthywater/swimming/rwi/
CDC. 2011. "Swimmer's Ear" Otitis Externa. Accessed: August 14, 2011 from http://www.cdc.gov/healthywater/swimming/rwi/illnesses/swimmers-ear.html
CDC. 2010. Who is Most Likely to Get Ill from a Recreational Water Illness (RWI)? Accessed: August 16, 2011 from http://www.cdc.gov/healthywater/swimming/rwi/rwi-who.html