What could be more refreshing on a hot day? A dip in the lake is just the ticket for relief from the heat. Even if the water looks clear, clean and inviting, what you view as a reprieve from intolerable heat may also be viewed as paradise to bacteria and germ population. Dangers associated with outdoor swimming are not prone to a particular group of community; the rich enjoy their holidays by the lakeside, while the poor who reside by the banks on a lake also enjoy the exquisite moments of swimming. In Rwanda, most of the frequented outdoor recreational waters include Lakes Kivu and Muhazi. These water bodies are frequented by many people, including local and foreign tourists. Doctors warn that such water is essentially untreated water and filled with unseen microorganisms known to be dangerous or deadly to a human body. If you accidentally ingest, inhale or come in contact with some of these microorganisms, you might get infections of waterborne diseases.According to medical specialists, one can get sick due to swimming in lakes or swimming pools due to various kinds of microbes. One drop of contaminated water can harbour millions of germs. Water is contaminated due to fecal matter, and urine of humans, birds and animals and also by washing and cleaning activities in the lakes. Germs enter our body during swimming, wading or bathing in water by water entering the mouth being swallowed into the gut.Dr Rachna Pande, an internal medicine specialist at Ruhengeri Hospital, says she has treated patients suffering from water-related diseases and has, herself, once suffered from otitis–an ear infection after swimming. Ruhengeri Hospital is near Lake Kivu.Dr Panda says the hospital receives many cases of otitis, sinusitis and fungal infections. She says they are definitely caused by swimming or bathing in lakes. "There are cases we suspect  such as schistosomiasis as those individuals have features suggestive of this disease and live near lakes. Unfortunately, we don’t have the diagnostic serological tests,” she adds. How bacteria enters our bodyWhen someone is swimming, there is a possibility of water entering through the nose to the air sinuses which is considered dangerous, same as water entering directly in the ears, from where germs can reach the brain at times.Medics say direct contact of water with skin and skin remaining damp during and after swimming can equally be dangerous. Also, chlorine, which is always present in treated water, causes inflammation of the skin, nasal and ear mucosa (the protective inner linings), thus disrupting them and making them more prone to infection.Water-related diseasesOne can get problems related to ear infection, brain infection, skin infections, intestinal infections and systemic disease just as a result exposure to unclean water."Some of those are caused by bacterial infections such as escherichia coli and shigellosis. These can cause acute or recurrent diarrhoea, might come with blood and mucous, with abdominal cramps, bloating, nausea and vomiting. A person may have one or more of these symptoms. Severe diarrhoea can be fatal due to renal failure and or shock,” Dr Panda says, adding that diagnosis is based on identifying causative germs, treatment is by suitable antibiotics.            Pseudomonas infection leads to resistant ear and skin infections, according to Dr Panda. It is manifested by ear pain, discharge, fever, skin eruptions. It is diagnosed microscopically and is treatable with antibiotics.Dr Panda said: "Simple upper respiratory tract infections like cold and cough can occur due to swimming. Bacterial infections can spread from nose to sinuses causing sinusitis manifesting as persistent headache. Brain can be infected via ear causing serious illness.”Another infection is spirochaetal, which occurs when one swims in water contaminated with urine of wild or domestic animals.  Fever, jaundice, body-ache, rash and petechial spots on skin are some diseases that accrue from contact with lake waters.  Dr Panda says another infection is the protozoa, which causes recurrent acute or chronic diarrhoea, bloating sensation in abdomen, malabsorption and malnutrition. The protozoa are easily identified in a stool sample and are treatable. Others include fungal infections and parasitic infections among others.  Prevention of infections while swimming in lakesGenerally, the classical way to avoid such infection is by avoiding swimming in water suspected to be contaminated. Dr Panda, however, recommends that someone should use protective plugs in ear and nose to prevent or minimise water entering them, keep mouth closed or if open avoid swallowing water ingested by spitting it out as soon as possible, avoid urinating or spitting while inside."Take a shower with clean fresh water immediately after swimming. Rinse mouth, eyes with fresh water. Try rinsing nose also with small quantity of fresh water. Avoid swimming if you have a cold, cough, sore, blister or wound anywhere on your body,” says Dr Panda.---------------------------------Swimming   pools are deadly people engage in various recreational activities that are dangerous and potentially life-threatening such as skydiving, rock climbing, mountain biking, and skiing.But recreational bathing, an activity that is supposed to be fun and safe, has become a health risk. Recreational bathing includes swimming in pools. People become ill due to consumption of contaminated water, sometimes even when this water has been adequately chlorinated or sanitised.There are several communicable diseases of concern that are commonly associated with recreational swimming. In an article published on scienceblog.com, Prof. Steven D. Levitt compares the dangers of a pool with a gun and concludes that when it comes to children, there is no comparison: a swimming pool is 100 times more deadly. ‘Unmanly’ effectsThis may sound quite unusual but a research published in the International Journal of Andrology found that chlorine, and the by-products of disinfecting water with the chemical, had an unmanly side effect on young boys. The researchers suspect that adult men could suffer the same fate, if swimming is a part of their daily exercise routine.In an article, Emily Main says: "When pool water is treated with chlorine, the chemical reacts with everything that’s in the pool: the water, ammonia from sweat and urine, and the dozens of other compounds from personal care products that wash off people while they’re swimming. Those reactions result in chlorination by-products such as chloramines, which can cause eye and respiratory irritation, and halogenated hydrocarbons, which animal studies suggest can damage a man’s testes and disrupt sperm development.”Because of the high levels of pollution in chlorinated swimming pools, chlorination by-products have the potential to disrupt a boy’s reproductive system, with similar impacts on adult men. The authors of the research collected blood samples from 361 boys aged 14 and 18, and compared them with how frequently they visited chlorinated swimming pools. Boys who attended chlorinated pools for more than 250 hours before the age of 10, or for more than 125 hours before they were seven, were three times more likely to have low sperm levels or testosterone than kids who swam in pools disinfected with copper and silver. The chlorinated pool swimmers sperm and testosterone levels were 20 per cent lower than average for children their age.  Chlorine and Kidney infection Recent studies show that sodium hypochlorite and similar chlorine compounds are dangerous for humans. The chemicals react with organic materials such as human body to form toxic substances that can cause many diseases such as kidney and liver infection.A research conducted by the Centre for Disease Control and Prevention, 2 per cent of the total victims of chlorinated water suffered from liver and kidney infections.Women and chlorine As the saying goes, the beauty of a woman lies in her hair – however this beauty will vanish if the hair is exposed to too much chlorine. Chlorine not only dries out hair, but can also affect the tint. To white with dark hair, you’ll probably fare better than blondes who run the risk of stepping out of the pool with green hair but they are all still prone to chlorine’s harsh effects.If you’re a swimmer, it’s really important to use a shampoo that is formulated for chlorine removal, and most clarifying shampoos do the trick.