Health Advice for the Returning Traveller; When to see the GP?

It’s the time of year again when all our backpacking students return from the four corners of the world. Some will be arriving for the first time in Bristol, as international students of course, and many of you will have been traipsing through the jungles/ beaches and villages of the world’s most remote places, possibly even to Coca-cola free zones!

Unfortunately, even if you did everything right, had every last jab, and took all your malaria pills, you may still be at risk of post-travelling illness, so here is a quick summary of what to watch for and what to act on;

  • Tell the nurse/ doctor exactly where you have been, and dates
  • Tell them if you worked in ‘at risk’ environments, eg in a hospital/ clinic
  • Most illnesses will be common conditions like pneumonia/ fungal skin rashes
  • Be honest about malaria tablet history and compliance
  • Report any treatment tried or taken overseas
  • Fever is a common symptom requiring medical attention in returning travellers, especially if it is accompanied by; rash/ jaundice/ breathing difficulties/ bruising/ persistent vomiting/ altered conscious level or paralysis (the latter are extremely rare with only 0.3% of unwell travellers ever requiring hospital admission).
  • Malaria commonly presents with fever, chills, sweats, headaches, muscle pains, nausea and vomiting.
  • Jaundice (yellowing of the skin, and whites of the eyes) can indicate Hepatitis, most commonly type A, from infected food and water.
  • Arbovirus infections (Dengue, West Nile and Chikungunya fevers) are the main cause of viral fevers in returning travellers, and tend to have short incubation periods, typically less than two weeks .ie you will show symptoms within 2 weeks of being infected.
  • Diarrhoea is extremely common in travellers, and those who develop three or more loose stools in an eight-hour period, especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools, may benefit from antibiotics.
  • Prolonged, severe diarrhoea with blood should be reviewed by a GP.
  • Skin rashes are very common, and should be reviewed by your GP if not settling, or if associated with fever.
  • The vast majority of travellers’ infections have a short incubation period, meaning that symptoms will start within 10 days or less from infection. The notable exceptions are schistosomiasis (bilharzia)/ malaria/ TB/yellow fever, and Q fever.



Therefore, if you continue to feel unwell despite being home, and eating and drinking normally for you, then please come and see one of the GPs. You may also find it useful to look at the following;




A Quick Dip

“Jump in”…

“Come on In” I hear them shout… The water looks cool and inviting, the surface twinkling under the sun. I’m hot and sweaty and in desperate need to feel cold water on my skin. I hear them all splashing in the water, laughing calling me in to join them… Beads of sweat have formed on my forehead, I wipe them away- my T-shirt has stuck to my back where I was carrying my daypack.

I do so want to run in, or at least take my sandals off and feel the coolness on my hot feet-  but something in my head tells me no… Why? I retrace my thoughts and vaguely remember something the nurse said in the travel clinic something about snails and freshwater…? and that Lake Malawi was high risk… ?

I can’t see anything in the water- I’m getting hotter and everyone is now in the water- calling me in to join them… What harm can it do?

 I take off my sandals and join in the fun- such a relief from the heat of the sun….

 I think nothing more of it… and 4 months later I am back in Bristol uploading my travel photos onto facebook. I find a selection of leaflets amongst my travel documents that I must have collected from the nurse in the travel clinic- one of them mentions something called ‘Schistosomiasis’ (Bilharzia).

Ahhhh this is the disease that I recalled at Lake Malawi- but I feel totally ok, not unwell at all- so I don’t think I have to worry about this. I start reading the information and it states:

‘The majority of people who contract Schistosomiasis have no symptoms’!


But fortunately I can have a screening test 12 weeks after possible exposure which I can have done at my GP practice.

I ring up Students’ Health Service and book a nurse appointment.

Better to check after my quick dip…


Schistosomiasis is one of the most widespread of all parasitic infections of humans. It is the most common parasite transmitted through contact, by either swimming or wading in fresh water in parts of Africa, for example Lake Malawi. South America and the Middle and Far East are also affected.

Initial contact with cercariae can cause an itchy rash, known as “swimmers itch.” Once infection has been established, clinical manifestations/ symptoms can occur within 2-3 weeks of exposure, but many infections cause no symptoms.


Advice for Travellers

Avoid skin contact with fresh water in endemic areas e.g. ponds, lakes and rivers. Swim only in protected swimming pools or safe sea water. Avoid drinking infected water. Wear protective footwear when walking in soil, especially if it is damp or water logged. Those who have been knowingly exposed can be screened after return but if there are no symptoms this should be delayed for 12 weeks after the last possible exposure so as to allow the time for the development of antibodies.



Students’ Health Service ‘Travel Guidelines’ patient information leaflet- available at the practice