A couple of reasons:
1. The disease needs to get from one host to another, and so that means stimulating contagious acts, such as sneezing, coughing, vomiting, diarrhea, etc.
2. The individual bacteria need nutrients, and that means taking them from you. Or for viruses, they need to destroy or hijack your cells in order to reproduce. Not only can this cause a drop in health directly, but it’s also a good reason for your immune system to attack them. That immune response is often the cause of the actual symptoms, depending on the specific disease.
Ideally, it would be better for the disease if it could go undetected (and many of them do for long periods), but logistically if there was no negative effect to an infection, we wouldn’t call it a disease. And hey, guess what? There’s a lot of microbes that are basically benign or even beneficial overall, and so they tend to be able to live in or pass through your body without causing any problems!
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