Inner turmoil is never good (Fimb)
Article Words : Dr Jane Wilson-Howarth | 01 March

Unwanted souvenirs

Dr Jane Wilson-Howarth helps you deal with some of the nastier bugs you can pick up on your travels

Most of us travel with almost subliminal health concerns, especially when visiting a less-well-resourced part of the globe. Although these thoughts are buried much of the time, they can haunt you – even when you’re safely back at home.

Images of that unimaginably squalid loo at Kathmandu airport get replayed over and over, and it’s easy to start thinking about how you may have caught something nasty. Much of that worry is unfounded, but there are a few long-lasting bugs that you should look out for.

An unwanted lodger

It is not uncommon for travellers to pick up the occasional roundworm. These squirmers have no hooks or suckers, so do little harm as they endlessly swim upstream in the bowel after you’ve accidentally swallowed a microscopic egg. Each adult worm outputs thousands of eggs a day, which emerge with the faeces. In very arid regions, such as the deserts of China and Ladakh, these faeces dry out and the worm eggs can become airborne and land on food or drinking water.

About a year after my first big trip – a six-month overland adventure to the Himalaya – I noticed an unusual sensation in my bottom while sitting on the toilet. It seemed I had unwittingly picked up one of these unpleasant lodgers and it was now making its exit.

I am pleased to report that a stool check courtesy of my GP said it was a loner and I needed no treatment. My roundworm had led a sad and unfulfilled life and had died of old age 12-18 months after I’d swallowed it. My slightly unsettled guts became calmer on losing my resident.

Unfortunately these are only one of a range of parasites that can get inside your insides, and some can be a lot more persistent. Any ongoing intestinal chaos after an exotic trip should be investigated – ask your GP.

Inner turmoil

Gut-rot generally hits within hours of a dodgy meal, but the reverberations can go on and on. Gastrointestinal turmoil often settles when you get home; however, a good proportion of travellers who have experienced a significant bout of travellers’ diarrhoea are left with something akin to IBS (irritable bowel syndrome) for months or years.

Be aware that giardia infection can mimic IBS, and a single stool check can miss diagnosing the parasites, especially if the medical laboratory technician who looks at the sample isn’t aware you’ve been abroad.

Anyone labelled with the diagnosis of IBS needs to be sure that the diagnosing doctor has thought about the possibility of intestinal parasites by getting three different stool samples checked.

Boils & ulcers

Skin problems can emerge during or soon after an exotic trip. Sometimes people can pick up a tendency to produce boils; this problem can usually be sorted once the offending bacterium has been identified by taking skin and nose swabs. Ulcers on the skin need to be shown to a doctor.

The ones you should worry about are painless lesions that go through a cycle (over months) of apparent healing then break down. This could be the unpleasant parasite leishmania or an unaggressive form of skin cancer.

What risks have you taken?

Some travellers have good reasons to be worried – if you have taken risks, you need to seek advice.

If HIV is a worry, you need to wait 12 weeks from the last time you were in contact with another’s bodily fluids before a screening blood test is meaningful. Similarly with schistosomiasis, there is no point in having tests sooner than six weeks after your last swim (in Africa). Screening is worthwhile though – if you have caught this long-lasting and debilitating infection, it is easily treated.

Another parasitic disease (one that is said to have killed Charles Darwin, eventually) is Chagas’ disease. It is a Central and South American infection acquired from assassin bugs. These – like bedbugs – have a painful bite, so you’ll know if you’ve been nibbled.

Bitten by the travel bug?

You may have been scratched or bitten by a pet or a semi-wild animal. You might even have been brave and scrubbed the wound with lots of soap under running water for five minutes before flooding it with alcohol. But on getting home you may wonder whether your first aid was enough. You are right to worry – go and get your post-bite rabies jabs sorted.

The good news

Back home, most of us will feel our worries are over. That friskiness of the bowel tends to calm down, and you can get expert advice in a language you understand.

It is reassuring to know that, although there are some horrible diseases, few cause trouble. Leishmania can cause a strange form of bronchopneumonia long after your return, but this is very rare. You can get funny fevers or even elephantiasis that manifest weeks after returning, but be reassured that the commonest, longest-lingering nasties are unlikely to do you great harm.

Discuss any symptoms or concerns with your GP; help them out by sharing where you’ve been on your travels lately. Don’t worry, act – get help or get screened.

Dr Jane Wilson-Howarth has been Wanderlust's travel health expert since issue one of the magazine. Her book Bugs Bites & Bowels (Cadogan, 2006) contains chapters on all major travel health issues