Traveler’s Diarrhea

What is traveler’s diarrhea?

Traveler’s diarrhea is a brief but unpleasant gastrointestinal infection that affects travelers and others who consume contaminated food or water. It typically causes loose poops (diarrhea) and abdominal cramps. Most of the time, bacteria cause traveler’s diarrhea, but sometimes viruses and intestinal parasites are to blame. Travelers are most at risk while visiting places that have less rigorous sanitation practices than their home countries.

Traveler’s diarrhea can derail the best-laid travel plans. Taking precautions, like washing your hands often and watching what you eat and drink, can reduce your risk. But even the most careful of travelers may pick up a case while they’re on the road. If that happens to you, get some rest, stay hydrated and know you’ll probably feel better in a few days.

How common is traveler’s diarrhea?

Traveler’s diarrhea is the most common travel-related illness. It affects between 30% and 70% of travelers, depending on the season and travelers’ destinations. It’s especially common in hot and/or humid climates, where bacteria breed more easily.

Most of Asia, the Middle East, Africa, Mexico and Central and South America have this type of climate at least some of the time, which means travelers to those places have more risk of developing traveler’s diarrhea.

What are the symptoms of traveler’s diarrhea?

You may have traveler’s diarrhea if you experience three or more loose poops within 24 hours. You may also experience:

• Urgent, frequent bowel movements
• Abdominal pain and cramping
• Nausea and vomiting
• Fever

Symptoms are usually mild. They may start within six to 24 hours after a bacterial or viral infection. But it can take one to three weeks for traveler’s diarrhea symptoms from an intestinal parasite to show up. That’s why some people may be home from their travels before they have symptoms.

How long do symptoms last?

That depends on the cause. If you have a bacterial infection, you’ll start to feel better within two to three days even if you don’t have any treatment. But it may take a week for your symptoms to go away. Traveler’s diarrhea symptoms that last for weeks or months may mean you have a parasitic infection.

What causes traveler’s diarrhea?

Traveler’s diarrhea is your immune system’s reaction to an infection in your gastrointestinal (GI) tract, in your digestive system. These infections can be bacterial, viral or parasitic. Regardless of the intruder, your immune system reacts by producing an inflammatory response to kill and remove them. That inflammatory response leads to traveler’s diarrhea.

What types of infections cause traveler’s diarrhea?

Bacteria, viruses and parasites can cause traveler’s diarrhea. The most common cause is bacteria, especially E. coli. Other common bacteria include:

• Salmonella
• Cholera
• Campylobacter jejuni
• Shigella

Viral infections may include:

• Norovirus
• Rotavirus
• Astrovirus

Parasitic infections may include:

• Giardia
• Cryptosporidium
• Cyclospora

Is traveler’s diarrhea contagious?

Yes, it is. In traveler’s diarrhea, germs from your gastrointestinal tract can spread through tiny particles of poop or vomit that linger on surfaces. Say you have diarrhea and touch the bathroom countertop before you wash your hands. If you don’t clean the countertop, the next person who uses the bathroom and touches the countertop could pick up germs. If they touch their mouth before they wash their hands, the germs you left behind could get into their digestive system.

What are the risk factors for traveler’s diarrhea?

The most common risk factor is consuming contaminated food and drinks. But certain groups of people have more risk than others, including:

• Young adults. Experts aren’t sure why, but young adult travelers tend to develop traveler’s diarrhea more often than older travelers. That may be because younger travelers are more likely to sample food and drink that could be contaminated.
• People with weak immune systems. Like other infections, traveler’s diarrhea is more likely to take hold in someone whose immune system is already stressed.
• People with underlying chronic gastrointestinal diseases. This may include conditions like Crohn’s disease, GERD or irritable bowel syndrome (IBS).

What are the complications of traveler’s diarrhea?

Dehydration is the most common complication, and severe dehydration can be a serious medical condition.

Less frequently, traveler’s diarrhea may trigger an underlying gastrointestinal disease. For example, you may develop post-infectious irritable bowel syndrome (PI-IBS). If you have a genetic tendency for inflammatory bowel disease, having traveler’s diarrhea may lead to your first IBD symptoms. Severe traveler’s diarrhea from a bacterial infection may cause symptoms like blood or mucus in your poop and fever.

How do healthcare providers diagnose traveler’s diarrhea?

Most of the time, your healthcare provider will recognize traveler’s diarrhea based on your symptoms and travel history. But in some cases, they may want to test a sample of your poop to find out what type of infection you have. This can help them determine the best medication to prescribe, especially if they suspect a parasite. Your provider may need to test more than one sample to identify the infection.

What are treatments for traveler’s diarrhea?

Your healthcare provider may recommend getting extra rest and hydration. Certain sports drinks and over-the-counter (OTC) sports rehydration formulas can help replenish lost electrolytes. But if your symptoms are severe or don’t go away, your provider may prescribe drugs like antidiarrheals or antibiotics.

Antidiarrheal drugs

These drugs treat your diarrhea, but not the infection itself. They work by slowing down your motility — the muscle contractions that move your bowels — giving your intestines more time to absorb more water from your poop.

The downside is you still have germs in your digestive system. You’re still sick and you’re still able to pass on an infection. It’s a good idea to include some of these common antidiarrheal drugs when you pack your bags:

• Atropine diphenoxylate (Lomotil^®)
• Bismuth (Pepto-Bismol^®)
• Loperamide (Imodium^®)

Antibiotics

Your provider may prescribe antibiotics if you have a severe bacterial infection or diarrhea doesn’t go away in a few days. Commonly prescribed antibiotics include:

• Ciprofloxacin (Cipro^®)
• Levofloxacin (Levaquin^®)
• Azithromycin (Zmax^®)
• Rifaximin (Xifaxan^®)
• Metronidazole (Flagyl^®)
• Nitazoxanide (Alinia^®)

Are there any natural treatments for traveler’s diarrhea?

Some natural antibiotics like oil of oregano or extract of echinacea may prevent the infections that cause traveler’s diarrhea. But talk to your healthcare provider first to make sure these treatments are safe for you to use.

Can traveler’s diarrhea be prevented?

You may not be able to avoid all the germs that cause traveler’s diarrhea. Taking the following steps may reduce your risk:

• Wash your hands often, especially before eating.
• Carry an alcohol-based hand sanitizer so you can clean your hands when you can’t wash them.
• Don’t swallow any shower water.
• Brush your teeth with bottled water.
• Avoid drinks with ice cubes that might be made from tap water.
• Avoid fresh produce unless you can peel it yourself.
• Stick to foods and drinks that are well-cooked and served hot.
• Stick to canned or bottled beverages.

What can I expect if I have traveler’s diarrhea?

If you’re like most people, you’ll feel better in a few days. If you have severe or persistent symptoms and you’re still traveling, ask the U.S. embassy to recommend local healthcare providers.

How do I take care of myself?

If you or your child has traveler’s diarrhea, the following steps may help:

• Drink up. Bottled water, certain sports drinks and over-the-counter oral rehydration solutions are all good sources of hydration.
• Eat, but take it easy. Start with clear soups and popsicles. Next try the BRAT diet: bananas, rice, applesauce and toast.

When should I see my healthcare provider?

Contact your healthcare provider if you develop the following symptoms:

• Blood or mucus that you spot after pooping or wiping
• Fever
• Three or more loose poops in a day even though you’re following treatment or taking medication