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a pre-travel vaccination means the post-bite treatment is greatly simplified. If an animal bites you, gently wash the wound with soap and water, and apply iodine-based antiseptic. If you are not pre-vaccinated you will need to receive rabies immunoglobulin as soon as possible, followed by five shots of vaccine over 28 days. If pre-vaccinated you need just two shots of vaccine given three days apart. Immunoglobulin is in short supply and you may well have to travel to Bangkok to get it.

STDs

Sexually transmitted diseases most common in Thailand include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when passing urine seek immediate medical attention. If you have been sexually active during your travels have an STD check on your return home.

Strongyloides

This parasite, also transmitted by skin contact with soil, is common in Thailand but rarely affects travellers. It is characterised by an unusual skin rash called larva currens – a linear rash on the trunk which comes and goes. Most people don’t have other symptoms until their immune system becomes severely suppressed, when the parasite can cause an overwhelming infection. It can be treated with medications.

Tuberculosis

While rare in travellers, medical and aid workers and long-term travellers who have significant contact with the local population should take precautions. Vaccination is usually only given to children under the age of five, and is highly recommended for children spending more than three months in Thailand. Adults at risk are recommended pre- and post-travel TB testing – either with the Mantoux test or Quantiferon blood test, depending on your country’s guidelines. The main symptoms are fever, cough, weight loss, night sweats and tiredness. Treatment is available with longterm multi-drug regimens.

Typhoid

This serious bacterial infection is spread via food and water. It gives a high and slowly progressive fever, severe headache, and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccination is recommended for all travellers spending more than a week in Thailand, or travelling outside of the major cities. Be aware that vaccination is not 100% effective so you must still be careful with what you eat and drink.

Typhus

Murine typhus is spread by the bite of a flea whereas scrub typhus is spread via a mite. These diseases are rare in travellers. Symptoms include fever, muscle pains and a rash. You can avoid these diseases by following general insect-avoidance measures. Doxycycline will also prevent them.

TRAVELLER’S DIARRHOEA

Traveller’s diarrhoea is by far the most common problem affecting travellers – between 30% and 50% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, traveller’s diarrhoea is caused by a bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics. Treatment with antibiotics will depend on your situation – how sick you are, how quickly you need to get better, where you are etc.

Traveller’s diarrhoea is defined as the passage of more than three watery bowel movements within 24 hours, plus at least one other symptom such as vomiting, fever, cramps, nausea or feeling generally unwell.

Treatment consists of staying well hydrated; rehydration solutions like Gastrolyte are the best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.

Loperamide is just a ‘stopper’ and doesn’t get to the cause of the problem. It can be helpful, for example if you have to go on a long bus ride. Don’t take Loperamide if you have a fever, or blood in your stools. Seek medical attention quickly if you do not respond to an appropriate antibiotic.

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Amoebic Dysentery

Amoebic dysentery is very rare in travellers