Last reviewed: 6 Nov 2021
Last updated: 02 Jul 2021



History and exam

Key diagnostic factors

  • diarrhea (with or without tenesmus), cramping, nausea, and vomiting
  • dysentery (blood and fever)
  • persistent diarrhea >14 days

Risk factors

  • travel to a high-risk destination
  • age <30 years
  • decreased stomach acidity
  • prior TD susceptibility
  • chronic disease, immunocompromise
  • travelers 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
  • multipathogen molecular diagnostic (polymerase chain reaction)
  • stool ova and parasite exam

Investigations to consider

  • protozoal stool antigens
  • Clostridium difficile stool toxin
  • colonoscopy, endoscopy, and biopsy
  • hematology, blood chemistries, serology

Treatment algorithm



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 traveler's diarrhea 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 traveler's diarrhea for the ISTM, ACG, and the 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.

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