What is traveler's diarrhea and what are the symptoms?

Traveler's diarrhea cannot be transmitted in the same way as a cold, that is, directly through particles emitted by breathing, but is essentially transmitted through ingestion of food or drink contaminated with the germs responsible.

The main symptoms of traveler's diarrhea are evacuation of liquid or semi-liquid stool and an uncontained urge to evacuate 3 to 5 or more times a day. Other symptoms concomitant with evacuations: 

• nausea,
• abdominal cramping and bloating,
• vomiting,
• fever,
• malaise,
• dehydration,
• malabsorption of food. 

In special cases, in those who have been suffering from traveler's diarrhea for days, mental confusion / spatial / temporal disorientation may also arise.

The duration of traveler's diarrhea is variable: from a minimum of 2 days to a maximum of 7-10 days. In some cases, however, it can be prolonged.

Water is among the main culprits of this intestinal disorder that can develop into pathology if not treated properly. Indeed, in some territories, water used for food and beverage preparation is not infrequently contaminated with microparticles of feces or wastewater from sewers or animal farms, which contain Escherichia coli, a bacterium found in human or animal feces that can cause traveler's diarrhea, or other pathogens (viruses and protozoa). 

Traveler's diarrhea is a condition that affects the intestines of both men and women indiscriminately, but more frequently it is the more fragile individuals who are affected: the elderly, children, people with previous illnesses (e.g., diabetic patients, patients with inflammatory bowel disease, immunocompromised patients or patients on antacid treatment, etc.).

Among the tourist destinations that most expose the Western traveler's gut to diarrheal episodes are exotic destinations and developing countries. This is due to the following causes:

• shortage of drinking water;
• differing habits: behavioral differences in the management of sanitation and food handling;
• poor prevention by the "do-it-yourself" or inexperienced traveler: little or no adherence to travel advice offered by the Travel Medicine Services of accredited public or private institutions, travel agencies, and tour operators specializing in travel to non-EU countries.

In general, no drugs are needed to treat diarrhea, which resolves on its own in a couple of days. If it does not stop, treatment depends on the symptomatology and duration of diarrheal events.

"The basic treatment is hydration in small sips, because a lot of fluids are lost with diarrhea; it can be helpful to supplement hydration with minerals and water of controlled origin," explains the doctor who specializes in travel medicine.

In adults, in the first 2 days it is useful to combine hydration with taking symptomatic drugs (pharmaceutical preparations to treat symptoms, etc.) to:

• reduce the number of discharges (loperamide-based antidiarrheals)
• compensate for electrolyte losses, especially potassium, that occur when diarrhea is profuse.

"In the event that symptomatics alone do not lead to a reduction in discharges, again in adults it is useful from day three to combine an antibiotic, such as levofloxacin or azithromycin, under medical supervision."

8 useful tips to prevent it

Reducing the risk of contracting traveler's diarrhea requires being especially careful about what you eat and drink, as well as some behavioral norms. Here are the main health allies and useful tips to prevent diarrhea:

1. Wash hands frequently, especially before touching food and drink; dry them using the air dispensers in the toilets or in the air rather than using the paper or cloth towels that may be available to guests and for mixed use. After washing hands, sanitize them with hydroalcoholic solutions before touching mouth, nose, eyes and food.
2. Drink water and other beverages only if they come from sealed bottles or, in the case of water, if it has been boiled and then made sterile.
3. Do not consume ice: when ordering drinks ask for them without ice (for prevention, there is no need to remove the ice because then cross-contamination has already occurred). Popsicles and slushies, sorbets and ice cream can only be consumed if they are industrially produced and purchased in unopened packages (not served loose).
4. Do not eat fruit with the peel and wash it only with sterilized water (brought to a boil at 100°) or from sealed water bottles after cleansing and sanitizing hands.
5. Do not eat raw vegetables and meat: to salads and cold cuts or cheeses prefer vegetables, meat and fish well steamed, grilled or fried.
6. Prefer cooked and very hot foods to those served at room temperature: heat helps prevent the proliferation of parasites, viruses and harmful bacteria that may be present in food or on food and dishes exposed to air (often without any protective barrier).
7. Avoid street food or choose fried street foods. Especially if frying takes place when the food is purchased, the high temperatures of the oil will offer greater assurance of the healthiness of the food than consuming pre-cooked and reheated food or food served lukewarm/cold.
8. Pack a first aid kit with anti-diarrheal and anti-nausea medications, as well as mineral supplements.