Last reviewed: July 2020
Last updated: August  2019



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

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

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


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.

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

Peer reviewersVIEW ALL

Assistant Professor of Pediatrics

Medical University of South Carolina




AS declares that she has no competing interests.

Professor of Pediatrics

Department of Pediatric and Adolescent Medicine

Mayo Clinic




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

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