not always apparently
'The first symptom is usually a sudden onset of feeling sick, which is followed by violent vomiting and watery diarrhoea. Vomiting is the most common symptom, but you may have diarrhoea without vomiting or vomiting without diarrhoea'
( Queef Smegwin U r a 🔔🔚, Wed 18 Dec 2024, 14:03, archived)

I was the world's worst catherine wheel.

( Undulating Tentacles of Love getting fun down to acceptable levels, Wed 18 Dec 2024, 16:27, archived)