From the Guidelines
It is possible for travelers' diarrhea to recur even decades after an initial infection, though this would not be the original infection returning. If you had travelers' diarrhea 30 years ago that was successfully treated, the current symptoms are likely a new infection or a different gastrointestinal condition.
Key Considerations
- The current symptoms warrant fresh evaluation and appropriate treatment based on your current condition, as the bacteria, parasites, or viruses that cause travelers' diarrhea do not typically remain dormant in your system for decades 1.
- For acute travelers' diarrhea, treatment typically includes antibiotics such as azithromycin (500 mg once daily for 1-3 days), which has been shown to be superior to levofloxacin in achieving clinical cure in certain settings 1.
- Azithromycin is generally well tolerated with minimal side effects, usually dose-related gastrointestinal complaints, and is considered the first-line agent in cases of dysentery (Strong recommendation, high level of evidence) 1.
Treatment Approach
- Fluid replacement is crucial to prevent dehydration - drink clear fluids and oral rehydration solutions.
- Loperamide (Imodium) can be used for symptom relief (4 mg initially, then 2 mg after each loose stool, maximum 16 mg/day).
- If your symptoms include high fever, bloody stools, severe abdominal pain, or persist beyond 3-5 days, seek medical attention immediately.
Long-term Effects
- Some people develop post-infectious irritable bowel syndrome after travelers' diarrhea, which can cause long-term digestive issues.
- The decision to treat TD with non-specific anti-diarrheal medications and/or an antimicrobial agent is based on assessment of the severity of illness and the effects it will have on the traveler’s activities and plans 1.
From the Research
Recurrence of Traveler's Diarrhea
- Traveler's diarrhea (TD) is a common health issue among international travelers, affecting millions of people annually 2.
- The risk of acquiring TD is influenced by factors such as destination, duration of stay, standard of accommodation, type of travel, age of the traveler, and individual risk factors 3.
- Most cases of TD are caused by bacteria, and treatment typically involves loperamide and antibiotics 4, 5, 3.
- While TD is usually self-limited, some travelers may develop chronic diarrhea or a persistent change in gastrointestinal function after an episode of TD 6.
- In some cases, an episode of TD or gastroenteritis can precede the onset of symptoms of irritable bowel syndrome, suggesting a possible link between the two conditions 6.
- There is no direct evidence to suggest that TD previously treated 30 years ago can recur, but the risk of acquiring TD is still present for travelers to high-risk areas, regardless of previous episodes 4, 5, 2, 3.