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3. The water can make you sick

The CDC warns hot tub users to avoid swallowing the water or even getting it in their mouths. Why? Because germs in the water can cause unpleasant and even life-threatening conditions.

Start with cryptosporidium, or crypto for short. The parasite, which lives in fecal matter, can cause gastrointestinal illnesses, including diarrhea. Crypto can be spread by an infected person using a hot tub. Older adults, as well as young children, pregnant women and people with compromised immune systems, are particularly susceptible. Anyone with diarrhea should avoid going into a hot tub to prevent the spread of crypto.

Even more common in hot tubs is Legionella pneumophila, a bacterium that can causeLegionnaires’ disease, a pneumonialike lung infection that is potentially serious, particularly for those ages 50 and older. Symptoms of Legionnaires’ disease include:

• Cough

• Shortness of breath

• Fever

• Muscle aches

• Headaches

In 2018 alone, health departments reported nearly 10,000 cases of Legionnaires’ disease. However, because the illness is typically underdiagnosed, it is believed the actual number may be up to 2.7 times higher than what was recorded.

A milder infection resulting from legionella known as Pontiac fever also results in fever and muscle aches.

4. The steam can make you sick, too

While there’s a risk of contracting Legionnaires’ disease or Pontiac fever by swallowing contaminated water, there's an even greater risk presented by inhaling contaminated water vapor emitted from a hot tub. That means if you sit near a hot tub without ever going in, there is still a risk of getting sick.

“When you turn the jets on in the hot tub, you're aerosolizing the water. In other words, you're making a mist of the water and putting it into the air,” said Michele Hlavsa, chief of the CDC's Healthy Swimming Program. “If those water droplets contain bacteria and they carry that bacteria into the air, if you inhale them, you can become infected.”

Legionella likes warm water, and when chlorine or bromine levels drop, the bacteria can survive and multiply in the slime, called biofilm, that appears on the walls of some hot tubs. Those who are in the hot tub or lounging nearby may want to take caution if they see the slimy substance.

People who are ages 50 and older, have weakenedimmune systemsand/or identify asformer smokersshould consider not using a hot tub or even sitting near one, the CDC says. Because the amount of water vapor around a hot tub can vary, there isn't a uniform distance from a hot tub that people with an increased risk for Legionnaires’ disease should maintain. But it should be at least a few feet away, Hlavsa advised.

5. You might get a rash

Pseudomonas is another bacteria partial to warmer water temperatures that can survive and multiply in a hot tub's biofilm. But rather than a respiratory infection, this germ can cause what's known as “hot tub rash.” Theskin infectioncan affect hair follicles and result in red, itchy skin and pus-filled blisters.

“You develop a rash basically wherever your skin came in contact with the hot tub water, so people will often find a rash pattern similar to their bathing suits,” Hlavsa said. “The bathing suit is holding water against their skin.”

To lessen the likelihood of hot tub rash, make sure to remove your swimsuit, wash it, and take a shower with soap after using a hot tub.

Editor's note: This article, originally published June 17, 2021, has been updated.