KAZAN, Russia

It started with nausea and vomiting. It ended with a winning strategy. And it was punctuated with a marriage proposal.

Simone Ruffini's victory in swimming's version of the marathon at the world championships Saturday involved a parade of emotions.

Despite throwing up twice during the opening lap on the Kazanka river, the Italian stood atop the podium under a light drizzle after the nearly five-hour 25-kilometer race and held up a marriage proposal for girlfriend and teammate Aurora Ponsele.

She said yes.

''It was tough but it went well in the end,'' Ruffini said after completing 10 laps back-and-forth across the river in 4 hours, 53 minutes, 10.7 seconds.

It was a two-man race in the end with Alex Meyer but the American dropped behind on the final stretch and took silver, 4.4 seconds behind. Bronze went to Ruffini's Italian teammate Matteo Furlan, 1:27.3 back.

''Already at the second feeding station I told my coach I wasn't feeling well,'' Ruffini said. ''I felt nauseous and I vomited twice. Once I calmed down I just tried to continue in a nice routine and do one lap at a time.

''In the last lap the American and I agreed to attack together and I sent him ahead a meter in front of me,'' Ruffini added. ''It's a risky tactic. I was worried he might betray me but when there were 400 meters to go he didn't have anything left.''

After he got out of the water, Ruffini rushed over to embrace Ponsele. Then he surprised his girlfriend with his hastily scribbled proposal on a piece of paper. When the camera flashed to Ponsele, she put her fingers into the shape of a heart.

''That was quite a shock,'' Ponsele said, adding that the couple had discussed marriage informally without making any concrete plans.

''We'll have the wedding after Rio,'' Ponsele added, referring to next year's Olympics in Brazil.

Meanwhile, Meyer seemed content with silver.

''Me and Simone Ruffini, we worked together as a team a little bit on that last lap and it pretty much guaranteed a top-two finish for both of us,'' he said. ''Obviously, I would have liked to pass him on the last little bit, but I laid it all out and that's everything I had.''

In the women's 25K, Ana Marcela Cunha won gold for Brazil with a dominating final lap.

With more than 5K remaining, Cunha and Hungary's Anna Olasz broke away from the pack before the Brazilian put in a final burst of speed to win in 5:13:47.3, with Olasz 26.1 behind.

It was Cunha's and Brazil's third medal of the championships after silver in the team event and bronze in the 10K.

While slapping the finish-board touchpad, Cunha hoisted herself up out of the water in celebration, showing off her purple mohawk. She said the victory will inspire her entering a home Olympics.

There was bronze for Germany as Angela Maurer took third, 1:20.3 off Cunha's time.

It was the eighth career medal at worlds for Maurer, who turned 40 this week.

''I'll enjoy it of course because I don't know, maybe it's my last worlds,'' Maurer said.

The United States finished top of the open water medal table with two golds, won by Haley Anderson in the women's 5K last week and Jordan Wilimovsky in the men's 10K on Monday.

The 10K is the only Olympic event in open water.