Treating Lingering Symptoms

Bradley Connor, M.D., discusses which lingering symptoms to take seriously.

In the mid-eighties, New York gastroenterologist Bradley Connor noticed that a lot of the patients at his practice were travelers returning from trips abroad. No one in his field studied the effects of travel on gastrointestinal health at the time, so he developed his own specialty and founded the Travel Health Services clinic ( An expert in post-travel medical issues, he answered a few questions about what to watch for after you’ve come home.

What symptoms do you see most in returning travelers?

The three most common complaints are fever, skin rash, and diarrhea, or post-diarrheic symptoms like cramping, bloating, and constipation.

What might a fever indicate?

In a traveler returning from a high-risk area, a fever is treated as malaria until we prove it isn’t. Otherwise, the consequences could be devastating. Occasionally we see typhoid or paratyphoid fever, but more often than not it’s influenza, bronchitis, sinusitis, or a urinary tract infection.

What causes skin rashes?

Various things. Sometimes a parasite has burrowed into the skin of someone who walked around in sandals or in certain sandy areas. We also see bad sunburns. And there’s an interesting thing called photodermatitis, particularly in travelers to Mexico, where they drink margaritas and if lime juice drips on their skin it sort of gets blanched in the sun.

And gastrointestinal problems?

Bacterial diarrhea usually gets better after a few days. If someone continues to have symptoms, that often turns out to be a parasite. We want to make sure they don’t have giardia or cyclospora.

If someone returns from a trip feeling fine, would you still recommend a checkup?

In general, no. If somebody had exposure that might have put them at risk, yes. We tell people not to swim in freshwater in Africa because of schistosomes, which are microscopic parasites. In some cases they cause swimmer’s itch. In other cases they don’t, but you can end up with schistosomiasis six months or a year later. Or if a patient was traveling with a coworker who came down with a terrible case of something, we check them for that. If someone is overseas for a while—say two or three months—it’s reasonable to do some baseline tests, even if they’re perfectly well. But for the average short-term traveler, no.