Symptoms of Traveler's Diarrhea
Traveler's diarrhea presents as the sudden onset of abnormally loose or liquid, frequent stools, most commonly accompanied by abdominal cramps (57%), with fever (13%) and nausea/vomiting (less than one-third of cases) occurring less frequently. 1, 2
Core Symptom: Diarrhea
- The hallmark symptom is loose or watery stools that the traveler recognizes as abnormal, with an average frequency of 4 bowel movements per day 2
- Watery and mucous stools occur in 99% of patients, while bloody diarrhea (dysentery) is rare 2
- The illness typically begins at the end of the first week of travel and lasts an average of 3.6 days 2
Associated Gastrointestinal Symptoms
- Abdominal cramps are the most common accompanying symptom, occurring in 57% of cases 2
- Nausea and/or vomiting occur in less than one-third of patients 2
- Severe abdominal cramping or tenderness may indicate more serious illness requiring medical evaluation 1
Systemic Symptoms
- Fever accompanies the acute illness in only 13% of cases 2
- When fever is present alongside diarrhea, this suggests a more invasive pathogen (Salmonella, Shigella, Campylobacter) that may require antibiotic treatment 1
- Constitutional symptoms including fever are more prominent when dysentery (grossly bloody stools) is present 1
Severity Classification Based on Functional Impact
The 2017 Journal of Travel Medicine guidelines recommend classifying TD by functional impact rather than stool frequency alone 1:
- Mild TD: Diarrhea that is tolerable, not distressing, and does not interfere with planned activities 1
- Moderate TD: Diarrhea that is distressing or interferes with planned activities 1
- Severe TD: Diarrhea that is incapacitating or completely prevents planned activities; all dysentery (passage of grossly bloody stools) is considered severe 1
Important Clinical Distinctions
- Dysentery is defined as passage of stools containing gross blood admixed with stool in the commode, often accompanied by more severe constitutional symptoms including fever 1
- Streaks of blood on toilet paper with normal-appearing stools likely represent hemorrhoids, not dysentery 1
- Persistent diarrhea is defined as symptoms lasting 2 weeks or longer 1
Functional Impact on Travel
- Among travelers with TD, 24% stop planned activities during their trip 3
- Approximately half of travelers with TD experience some limitation of activities during their trip 4
- Up to 10% may experience persistent diarrhea or other complications 4
- Hospitalization occurs in approximately 2% of cases 3
Common Pitfalls in Symptom Recognition
- Do not rely solely on stool frequency to assess severity—a small number of stools with fever and severe cramps may be more disabling than six watery stools without systemic symptoms 1
- Bloody stools are not an expected manifestation of C. difficile infection, so consider other pathogens when blood is present 1
- Travelers are unlikely to carry thermometers, so discuss symptomatology associated with fever (chills, body aches, malaise) before departure 1