Common Recreational Water Illnesses and How to Prevent Them

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Swimming is usually safe, but there is a small chance you can get sick from swimming in unclean or contaminated water. Recreational water illness (RWI) describes the many waterborne infections that can affect different organs in your body. The most common symptom is diarrhea.

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.

Three kids jumping into a lake

Vast Photography / Design Pics / Getty Images

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:

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.

RWIs are not usually spread from person to person through touching, kissing, or most sexual contact. Rashes from hot tubs and swimming pools are generally not contagious.

 Common Source of Contamination Pathogen/Disease Routes of Transmission
Brackish water or saltwater -Cholera
-Naegleria fowleri
-Drinking contaminated water (cholera)
-Exposure through the nose (N. fowleri)
Fecal (stool) contamination -Campylobacter jejuni -E. coli
-Typhoid fever
-Swallowing contaminated water
Groundwater contamination -Cryptosporidium
-Swallowing contaminated water
Sewage run-off -Amoebiasis
-Swallowing contaminated water
Swimming pools and hot tubs -Pseudomonas aeruginosa -Prolonged skin exposure
-Exposure through the ear canal
Urine-contaminated water -Leptospira -Swallowing contaminated water


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.

In some cases, the cause of an RWI may be presumed if there has been a local outbreak (such as with Giardia or Cryptosporidium) or you've traveled to an area where diseases like cholera or typhoid are common. In cases like these, treatment may be started presumptively while tests are performed to confirm the infection type.


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.


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.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Perkins A, Trimmier M. Recreational waterborne illnesses: recognition, treatment, and prevention. Am Fam Physician. 2017 May 1;95(9):554-60.

  4. Centers for Disease Control and Prevention. Norovirus.

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By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.