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Some twenty to fifty percent of Americans visiting the tropics get what is called “Montezuma’s revenge,” the “Skitters” or, in Spanish-speaking countries, “turista." Its symptoms include loose and watery stools, nausea, bloating, abdominal cramps, and sometimes fever and malaise. Fortunately, it is a self-limiting disease. Even if untreated, its symptoms usually go away in three or four days.

If diarrhea lasts more than four days or is accompanied by severe cramps, bloody stools, or foul-smelling gas, the individual should see a physician. Most travelers’ diarrhea is caused by a special strain of the common intestinal bacteria Escherichia coli. This strain of Escherichia coli, as it usually known, accounts for at least forty percent of all travelers’ diarrhea. Other bacteria, such as the ones responsible for salmonellosis and shigellosis, can also cause diarrhea, as can such parasitic conditions as giardiasis and amebiasis.

Whatever the cause, the best way to treat travelers’ diarrhea, the experts say, is to prevent it. Most diarrhea-causing organisms are waterborne, passed on in untreated water or by food handlers who have not washed their hands adequately. Savvy tourists will avoid using untreated or suspect water in areas where travelers’ diarrhea is common. This includes not drinking tap water or using it to brush your teeth) even in good hotels), not using ice in sodas, or alcoholic drinks, and not mixing alcohol with water.

It’s also smart to skip milk and other diary products unless you are sure they have been pasteurized. For brushing your teeth or drinking in your hotel room, boil the water you intend to use for at least five minutes or add water purification tablets. Avoid bottled water unless it is carbonated. Drink carbonated beverages, beer, wine, and coffee or tea. And wipe off bottle or can tops before drinking from them.

Also be cautious about food, especially in developing countries. Don’t eat raw vegetables, fruits, meats, or seafood. Avoid cold buffets left in the sun for several hours, garden or potato salads, and food from street vendors. Eat only hot cooked meals, fruits you have peeled yourself, and packaged foods.

If despite all your best efforts, travelers’ diarrhea strikes, medical experts and experienced travelers alike recommend that you drink plenty of fluids to replace the water you have lost and adding oral rehydration packets to fluids to replace lost minerals. Additionally, several prescription and over-the-counter drugs will relieve diarrhea symptoms or kill bacteria that cause the disease.