Traveller's diarrhoea

Last reviewed: 3 Jan 2023
Last updated: 02 Jul 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • diarrhoea (with or without tenesmus), cramping, nausea, and vomiting
  • dysentery (blood and fever)
  • persistent diarrhoea >14 days
More key diagnostic factors

Other diagnostic factors

  • diarrhoea without illness
Other diagnostic factors

Risk factors

  • travel to a high-risk destination
  • age <30 years
  • decreased stomach acidity
  • prior TD susceptibility
  • chronic disease, immunocompromise
  • travellers with prior residence in developing country visiting friends and relatives
  • travel during hot and wet seasons
More risk factors

Diagnostic investigations

1st investigations to order

  • stool culture and sensitivity
  • stool occult blood
  • multi-pathogen molecular diagnostic (polymerase chain reaction)
  • stool ova and parasite examination
More 1st investigations to order

Investigations to consider

  • protozoal stool antigens
  • Clostridium difficile stool toxin
  • colonoscopy, endoscopy, and biopsy
  • haematology, blood chemistries, serology
More investigations to consider

Treatment algorithm


pre-travel prophylaxis


non-pregnant adults: mild diarrhoea

non-pregnant adults: moderate diarrhoea

non-pregnant adults: severe diarrhoea





Mark Riddle, MD, MPH&TM, DrPH, C Trop Med, Certificate in Travel Health

Professor and Chair

Department of Preventive Medicine & Biostatistics

Uniformed Services University of the Health Sciences




MR has given talks on the management of traveller's diarrhoea for the International Society of Travel Medicine (ISTM), CDC Foundation, American College of Gastroenterology (ACG), and American College of Preventive Medicine. MR has led the development of guidelines for traveller's diarrhoea for the ISTM, ACG, and the US Department of Defense. This work has been unpaid but support for travel has been accepted. MR is an author of several references cited in this topic.


Dr Mark Riddle would like to gratefully acknowledge Professor Gregory Juckett, the previous contributor to this topic.


GJ declares that he has no competing interests.

Peer reviewers

Andrea Summer, MD

Assistant Professor of Pediatrics

Medical University of South Carolina




AS declares that she has no competing interests.

Phil Fischer, MD

Professor of Pediatrics

Department of Pediatric and Adolescent Medicine

Mayo Clinic




PF is an author of a reference cited in this topic.

  • Differentials

    • Irritable bowel syndrome
    • Secondary disaccharidase (or other dietary) deficiency
    • Malabsorptive conditions
    More Differentials
  • Guidelines

    • CDC Yellow Book: travelers' diarrhea
    • 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea
    More Guidelines
  • Patient leaflets

    Diarrhoea in adults

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer