What to know about traveler’s diarrhea

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Traveler’s diarrhea (TD) is the most common travel-related illness. It regularly affects millions of international travelers that visit countries with different sanitization standards and can significantly disrupt travel plans. Evidence suggests that the incidence of TD ranges from 30–70% of travelers, depending on the destination and season of travel.

Health experts may define TD as 3 or more loose stools in a 24-hour period during a trip abroad to a country with different hygiene practices. It often presents with other symptoms, such as nausea and vomiting. The onset of symptoms may be during or within 10 days of travel and typically lasts for 3–5 days.

TD typically occurs following the consumption of contaminated food or water. Different types of pathogens, such as bacteria, viruses, or parasites, can cause TD. However, most cases occur predominantly due to bacteria in areas with poorer hygiene. Contamination of food and water may result from:

• not properly washing hands
• unsafely storing food
• handling and preparing food unsafely
• not cleaning surfaces and utensils safely

Common causative agents of TD include:

• enterotoxigenic Escherichia coli(ETEC)
• Campylobacter jejuni
• Shigella species
• Salmonella species
• norovirus
• rotavirus
• Giardia intestinalis
• Cryptosporidium
• Entamoeba histolytica

TD can occur anywhere, but evidence notes that the highest-risk destinations include:

• Asia, except for Japan and South Korea
• the Middle East
• Africa
• Mexico
• Central America
• South America

Symptoms of TD may include:

• frequent loose stools
• nausea and vomiting
• fever
• abdominal pain and discomfort
• stools containing blood or mucus

Symptoms typically appear during or shortly after a period of foreign travel. The symptoms and duration of TD may vary depending on the causative agent. For example, without treatment bacterial or viral diarrhea may last for a few days, while protozoal diarrhea can persist for weeks or months.

To diagnose TD, a doctor will initially ask about a person’s health history, symptoms, and about any recent travel. In some cases, a doctor may order stool culture or other tests to help identify the causative agent.

Most symptoms last less than a week. However, a doctor may request further tests if a person has symptoms that persist for longer.

In many cases, symptoms of TD resolve in a few days. As such, treatment often involves fluid replacement to avoid dehydration. This can include drinking plenty of fluids such as clear broths and beverages rich in electrolytes. Other treatment options may also help to reduce the severity and duration of symptoms and lessen the interruption to travel plans.

For example, people may consider taking over-the-counter (OTC) options such as loperamide and bismuth subsalicylate. Loperamide is an anti-diarrheal that slows the contractions of the intestines and how quickly its contents pass through. Bismuth subsalicylate works by increasing fluid absorption and reducing inflammation in the stomach.

Click here to learn more about medications for diarrhea.

In more severe cases where symptoms persist, a person may require medications that target the causative agent. For example, if a person is experiencing TD due to an E. coli infection, a doctor may suggest an antibacterial drug, such as rifamycin. However, it is important that a person only takes prescription medication exactly as a doctor recommends.

A 2019 review highlights the importance of pre-travel education to help prevent episodes of TD. Often, this involves selecting food and drinks carefully and frequently washing hands. Tips to prevent TD may include:

• Hygiene practices: Practicing good hand hygiene by washing hands with soap and water, where available, or hand sanitizer can help prevent TD.
• Food and water basics: Where possible, go for foods that are served hot and well-cooked. Try to avoid undercooked meats and fish, as well as unwashed fruits and vegetables.
• Medications: Taking certain medications before experiencing symptoms may help to reduce the severity. However, it is always important to check with a doctor before taking any medications or supplements.
• Vaccines: Some vaccines, such as Dukoral which protects against cholera and TD, may help prevent people from experiencing symptoms.

A potential complication of TD is dehydration from losing body fluids due to diarrhea and vomiting. As such, it is important to receive treatment and replace fluids where possible.

Typically, most cases of TD resolve in a few days. However, some people may experience prolonged symptoms. An ongoing infection may occur due to immunosuppression, a sequential infection, or parasitic TD. For example, the parasite Giardia often causes symptoms that may take 2–4 weeks to resolve.

Some people may also develop post-infectious irritable bowel syndrome following a bout of TD. This refers to IBS-like symptoms, such as abdominal pain and changes to bowel movements, after a gastrointestinal infection. In other individuals, persistent symptoms may relate to an underlying gastrointestinal condition, such as celiac disease, Crohn’s disease, or ulcerative colitis.

Traveler’s diarrhea describes a gastrointestinal infection that a person may acquire when visiting an area with different hygiene practices. It typically occurs from consuming food or water contaminated with bacteria, viruses, or parasites.

Symptoms can include loose stools and vomiting, which typically resolve in a few days. However, in some cases, symptoms can persist for a few weeks. OTC medications can help to reduce symptoms. With prolonged symptoms, a doctor may prescribe different treatments. Preventive tips include frequent handwashing and carefully selecting food and drinks.