Common health queries

Even though you may have thought carefully about the health aspects of your holiday and taken all the sensible precautions, it’s impossible to reduce the risks to zero. Most people will have only minor problems or none at all, but, if difficulties do arise, the important thing is to know what to do about them. If you are worried about any symptoms, however minor they seem, it’s worth getting medical advice, just to be on the safe side.

Common skin problems

With a little care and forethought, you should be able to avoid some of the skin troubles that are among the most common holiday health problems.

A priority must be to steer clear of sunburn, but sometimes the worst happens despite good intentions. Treatment is to stay out of the sun, preferably in cool air conditioning, and drink lots of non-alcoholic fluids. When only small areas of skin are affected, just those areas can be protected from the sun until they’ve healed. Calamine lotion is often soothing. Aspirin, for those who can take it, helps to relieve the pain and inflammation. Paracetamol in appropriate doses should be substituted for children under 12 and anyone else who can’t take aspirin. When the sunburn is severe, you should seek medical help. Special blister dressings are now available.

When your feet are aching from sightseeing or have been rubbed by your shoes, try soaking them in warm, slightly salty water, which is refreshing and may discourage infection of broken skin. On walking holidays much discomfort can be avoided by ‘walking-in’ hiking boots well beforehand and using seamless, moderately thick socks. If you develop blisters, stop wearing the footwear that caused them for a while if possible. Don’t puncture a blister unless it is really necessary because the skin below will then be open to infection. If it has to be lanced in order to get your boot or shoe back on, at least temporarily, try to use a sterile needle, apply non-stinging antiseptic and a soft pad dressing.

In hot climates, and especially humid ones, minor abrasions and scratched insect bites can become infected much more quickly than at home. Antiseptic should be applied to all such minor wounds as a preventive measure. Any signs of infection that develop despite this should be seen by a doctor in case antibiotics are required. It’s difficult not to scratch mosquito bites, but this does encourage infection. Antihistamine tablets reduce the itching and swelling from bites but can make some people drowsy.

Another common itchy skin problem is prickly heat. It is caused by blocked sweat ducts and fine bumps can be felt on the surface of the skin in the affected areas. There is no real prevention or treatment apart from staying cool. Loose pure-cotton clothes help, as does gentle washing in tepid water and patting dry without rubbing.

Sweating aggravates fungal infections of the groin and athlete’s foot. Again, loose cotton clothing will help as will open sandals. Keep the area clean and don’t rub it hard. If you know that you are prone to this particular problem, it’s worth carrying some antifungal powder in your first aid kit.

Bright sunlight may cause a photosensitivity rash for holidaymakers on some medications. There is a wide range of drugs that can occasionally cause this problem and, if you experience it, try to reduce your exposure to sunlight and seek help from a local doctor. Be sure that you know the generic (proper) name and not just the trade name of any medication from home.

Most of the above skin problems are worse in hot climates, while chilblains and cold injury can be a problem for those on active holidays in cold climates. Wearing the right clothes and making careful plans in advance should reduce the risks.

Sexual encounters

Many people see unexpected sexual encounters with people they meet while travelling as harmless fun and part of what makes holidays different from normal, everyday life at home. Their partners might be other holidaymakers or local people, but, either way, it’s important to bear in mind the potential health risks of sex with strangers. Remember that in some tropical regions, hepatitis B and HIV (AIDS) infections are particularly prevalent and are commonly transmitted during sex between men and women. In fact, it is thought that about three-quarters of HIV and AIDS infections in the UK acquired heterosexually can be attributed to sex with a partner abroad. Not all those affected were holidaymakers – some were people living overseas. However, the danger should be considered.

The risks of sex with prostitutes and drug addicts should already be well known. Despite this, sex tourism and sex on business trips flourish, particularly in parts of south-east Asia, and there have been tragic cases of HIV being passed from a husband who travelled to a wife who had never left home.

As well as HIV and hepatitis B, there are other, much more common, sexually transmitted infections (STIs) such as gonorrhoea, herpes and chlamydial infection. The last has recently been implicated as a cause of infertility and highlights the possible long-term consequences of such an infection. Any open sores from STIs increase the chance of HIV transmission.

STIs including AIDS are not confined to the tropics and there have been sad cases of infections caught during student trips around eastern Europe. In fact, no geographical area can be considered safe.

After a ‘risky’ encounter on holiday you can go for a confidential check at a clinic for STIs and obtain treatment if required. Advice can be obtained from the National AIDS Helpline (see ‘Useful information’).

Safer sex

For those who don’t choose the safest option of abstinence, the following guidelines should reduce their level of risk:

• Travel with your husband/wife/partner
• Try not to engage in casual sexual encounters
• More partners means more risk
• Prostitutes and injecting drug users are higher risk
• Using a condom reduces (but does not eliminate) the risk
• Carry condoms from the UK: they may not be easily available abroad, may be of poor quality, and in Asia may not be a suitable size for westerners
• Safer sex means preventing semen, vaginal fluids or blood passing from one partner to the other
• Spermicidal creams used together with condoms may help to reduce viral infections, although over-frequent use can damage the skin
• Alcohol (and drugs) makes people more inclined to take risks without considering the possible consequences
• It’s not always apparent from someone’s personal appearance whether he or she is a ‘safe’ sexual partner

How to ask for condoms abroad

Illegal drugs

Any encounter with illegal drugs abroad may carry even greater risks – both legal and health related – than it would at home.

The most obvious is that injecting carries a risk of hepatitis B and HIV, and taking recreational drugs may increase other risks by clouding judgement.

As recent media headlines have made clear, involvement in illegal drugs carries severe penalties, including death, in many countries. Some of those accused have pleaded that they did not know drugs had been planted on them, so you need to be ultra-cautious.

• Avoid ANY involvement
• Do not take any luggage or packets through customs for others
• Do not leave your luggage unattended when items could be added without your knowledge.

Dental problems

Reluctant as many people are to make a trip to the dentist, having to visit a dentist in underdeveloped areas overseas can be a much more frightening experience. Most worrying are the risks of infections, such as hepatitis B or HIV, from non-sterile instruments and needles, and poor hygiene procedures. But there can also be a risk of water-borne infections because a continuous water supply is necessary for dental procedures such as drilling.

Reduce the chances of having to visit a dentist abroad by having a thorough dental check-up before you leave. This may need to be arranged a few months in advance, depending on the treatment needed. For those going on prolonged trips, tell the dentist about your plans because it will be a good opportunity to identify any foreseeable problems.

If you have had a dental abscess in the past, it may be a sensible precaution to travel with a supply of antibiotics; discuss this with your own dentist or doctor before you go. Remember to take a supply of painkillers with you. Those who routinely take antibiotic cover for dental treatment may like to take a supply with them.

Dental emergencies

Warm saline mouthwashes may help to alleviate pain caused by infection, as may oil of cloves, until you can reach a suitable dentist. If you have a supply of antibiotics these can be taken as instructed by your dentist.

It is sometimes possible to repair chipped teeth, replace lost fillings or re-cement crowns and bridges temporarily by using materials that are available in dental repair kits (however, they can be tricky to use). These are available in travel clinics and some pharmacies. If you use one of these kits to re-cement a crown or bridge, make sure that the inside of the restoration is clean and try it to make sure that it sits properly before mixing the cement. Make sure that the restoration is not loose once re-cemented, in case it is swallowed or inhaled.

If you are unfortunate enough to have a permanent front tooth knocked out, it may be possible to re-implant it if expert help is reached quickly. Clean it carefully by rinsing it in clean water. Make sure not to touch or brush the root.

Replace the tooth gently in its socket, making sure that it is the right way round and hold it in place until you reach a dentist. Immediate expert advice is essential because there is a very real risk of developing an infection, including tetanus, against which protection can be given.

If you are unable or unwilling to re-implant the tooth yourself, you should keep it moist by placing it in clean salty water or milk until you can get to help.

The sooner specialist help is reached, the better the chance of success, which decreases significantly if a delay of more than two hours occurs.

International hotels, embassies or consulates should be able to recommend a suitable dentist. Before undergoing treatment remember to tell the dentist about any medical problems that you may have because they will not be familiar with your medical history.

Where there are language problems it is usually possible to arrange a translation service through international hotels.

Cuts and open wounds

Try to wash your hands before you deal with a wound. Even minor wounds such as scratched insect bites can go septic in tropical climates, so do your best not to scratch and apply some antiseptic to even quite minor abrasions.

Wounds should be washed in clean water, with a few drops of very dilute antiseptic liquid.

Any dirt left at the bottom of a wound, even a small puncture wound, can be a tetanus (or other infection) risk and medical help should be sought if you cannot clean it completely.

Cover the wound with a piece of light gauze so that the air can get to it and hold the gauze in place with sticking plaster or a bandage. Keep dry as much as possible to help healing.

If the wound needs stitching together, get medical help which may also be necessary for wound cleaning, antibiotics and tetanus (or, in some countries, rabies protection if an animal was involved).

Coral cuts often become infected because of the tiny pieces of coral debris that cannot always be seen at once. The wound needs very thorough flushing with water at the time and antibiotics may be needed.

Fever and flu

A fever or a high temperature can be a sign of many diseases. Always check the temperature with a thermometer; normal is 37 degrees Celsius or 37°C (98 degrees Fahrenheit or 98°F).

Try to work out the cause of the fever, especially if it is above 38°C (101°F). Colds and flu are still the most common causes even when travelling. That is why anyone in whom flu (influenza) could be more serious and is advised to take flu vaccine in the UK should try to obtain the vaccine for travelling. Remember that flu is not seasonal in the tropics and that it can spread quickly among groups of travellers, for example those on cruises. However, flu vaccine is likely to be available only to those travelling from the UK for a few months from October onwards and has to be renewed each year as the virus changes. Sometimes bowel infections cause a temperature. Most of these will settle without danger in otherwise well adults, but any fever should be watched carefully and the patient should rest.

Emergencies to watch for are fever in someone who has been to, or is now in, a malarial area (not in the first week); it could be malaria even if there is diarrhoea. Neck stiffness and fever, usually with headache, could be signs of meningitis. Chest symptoms suddenly becoming worse could be pneumonia. If any deterioration occurs medical help should be sought immediately.

Other reasons to see a doctor at once would be for any fever in children or elderly people, or in adults who have fever for 48 hours or who become confused, drowsy or seem ‘ill’, and any fever over 40°C (104°F).

While waiting to see the doctor, fever can often be reduced by tepid sponging of the skin, but don’t let the patient get cold. Aspirin (for adults with no bleeding tendencies) or paracetamol for children helps to reduce a temperature. Drinking or sipping water is advised for conditions causing fever.

It may be helpful to have antibiotic treatment for those with a fever who are far from medical help so that self-medication can be used in an emergency until proper treatment is obtained. Some doctors are prepared to give a private prescription for this purpose. Others do not agree that ‘blind’ treatment is appropriate.

Diarrhoea

Know how to treat travellers’ diarrhoea

Most bouts of holiday diarrhoea are short term and inconvenient rather than serious. Replacing the fluid lost during diarrhoea or vomiting helps recovery.

Drinking lots of ‘safe’ water, juice or weak tea will help. Where these are not available, carbonated drinks from well-known manufacturers are usually canned or bottled in a hygienic manner, although in some situations they have more sugar than is ideal. For children and elderly people, it is even better to drink an oral rehydration solution, which contains the right amount of salt and sugar to help to restore the balance. Commercial sachets are available at pharmacies. The mixture should never be reconstituted in a more concentrated form than instructed on the packet. The home-made mixture shown in the box below can be used where commercial preparations are not available.

Oral rehydration solution

For adults this can be made as follows:

• One teaspoon of sugar and a pinch of salt in a glass or mug (approximately 250 millilitres) of safe water
• The drink should not be more salty than tears and can be flavoured with a little fruit juice
• Where vomiting is a problem, sipping the solution every five minutes may allow some to be absorbed

Children become dehydrated quickly and medical help should always be sought early (see also ‘Women and children only’).

Fatty foods and alcohol should be avoided, but it is no longer considered necessary to stop eating. Moderate amounts of biscuits, bread and starchy foods usually shorten the illness.

‘Stopper tablets’ for diarrhoea will often help and allow the patient to feel better. They are given only to children under 12 on a doctor’s prescription and are unlikely to be prescribed for very small children.

If the symptoms become severe with fever or blood in the faeces, or if the symptoms do not settle, then medical treatment should be sought. This is urgent if the patient becomes confused.

An antibiotic for self-treatment of travellers’ diarrhoea or dysentery is sometimes requested before travel. In most cases, the infection will get better without it. However, if the correct tablet has been chosen it will shorten the illness, and so may be worthwhile considering. Although there is a small chance of side effects, these are unlikely with the short courses normally used. Ciprofloxacin is the most common choice for this purpose.

Broken limb

Medical attention is required if you suspect a fracture. Meanwhile stop any bleeding by direct pressure with a cloth or shirt held firmly over it. Keep pressing until the bleeding stops. It may take 20 minutes or much longer.

Try not to move the injured part. In an emergency, if the person has to be moved, keep the broken bone from moving by splinting it. Make a splint from the joint above the fracture to the joint below and pad it if possible. For a broken leg, it is easier to use the other leg as a splint, tied with bandages or shirts and padded between the legs with T-shirts.

Getting assistance

For any serious medical emergency contact your travel medical insurance assistance number. They will usually tell you whom to contact locally. The insurance company may like to be contacted by telephone or fax before you run up any medical bills. If that is not possible obtain receipts from anyone you pay.

Other sources of assistance are hotel doctors; even if you are in an apartment, you usually know or can find out where there is an international hotel.

The British Embassy or High Commission may be able to advise about a local hospital or doctor, and offices of the major airlines and travel companies, and the local tourist office, may also know doctors who speak English. The telephone book may be useful to find the number of the main hospital, and it may mention a university or medical school affiliation, which could mean that English is spoken. Outside main tourist areas, you may have to ask in the first police station that you come to. Pre-planning before the event includes a phrase book to ask for a doctor in the local language.

There is an organisation, IAMAT (International Association for Medical Assistance to Travellers), that can provide a list of English-speaking doctors overseas who will see travellers for a fixed fee schedule. You can request the list on joining (no fee but donations encouraged) (see ‘Useful information’).

For anyone travelling alone it could be worthwhile carrying a document on your person with your name, a home contact, your embassy telephone number and your passport number, just in case you were found unconscious.

Key points

• Know how to treat travellers’ diarrhoea in otherwise well adults; seek early medical attention for children, elderly people or those with a fever or blood in the stools

   

• In tropical climates, loose cotton clothing can help to prevent many common skin complaints

   

• Scratched insect bites and minor abrasions can become infected in hot humid

   

• climates; apply antiseptic to prevent infection and seek medical attention if it becomes necessary

   

• Any fever should be investigated promptly if the sufferer is in a malarial area or has returned from one (especially in the last three months, but even right up to a year later)

   

• Casual holiday sex could lead to serious infections including HIV and hepatitis B or C, or could result in infertility