Diarrhoea is the most frequent health problem among travellers in the tropics. However, data on the spectrum and relevance of enteropathogens in international travellers with and without diarrhoea are limited. Stool samples from 114 cases of diarrhoea in travellers returning from the tropics were collected for microbiological examination and PCR for norovirus genogroups I and II, enteroaggregative Escherichia coli (EAEC), and enterotoxigenic E. coli (ETEC) producing heat-labile toxin (LT) and heat-stable toxin (ST). Travel and laboratory data of cases were compared with those of 56 travellers without diarrhoea. Among cases, EAEC was found in 45% of stool samples, followed by LT-ETEC (20%), ST-ETEC (16%), Blastocystis hominis (15%), Campylobacter jejuni (12%), norovirus (11%), Giardia lamblia (6%), Shigella spp. (6%), and Salmonella spp., Cryptosporidium spp., and Cyclospora cayetanensis (3% each). However, only for EAEC, ST-ETEC, Blastocystis and Campylobacter was the prevalence significantly higher among cases than among controls. Co-infections were common: 61% for cases and 13% for controls. The most common travel destination was Asia (54%), followed by Africa (35%) and Latin America (9%). The highest relative risk for diarrhoea was calculated for travellers to West Africa, East Africa, and South Asia. In this study, EAEC, LT-ETEC and ST-ETEC were detected most frequently in cases of travellers' diarrhoea. Although enteric infections with EAEC, ST-ETEC and Campylobacter often cause diarrhoea, the pathogenetic relevance remains unclear for most of the other enteropathogens, because of significant prevalence rates also being seen in controls without diarrhoea and the high frequency of co-infections.

Many PLHIV consult their HIV-physician regularly for medical follow-up and also indicate that HIV-physicians should be the source of information concerning SRH counselling. HIV-physicians should take advantage of their key role in HIV care and strengthen their efforts to integrate SRH services in routine HIV care.

The second trimester is the safest time for travelling, because the pregnant woman feels generally most at ease and the risk of spontaneous abortion and pre-term labour is very low. Possible risks must be discussed with the obstetrician before travelling. If the pregnancy is uncomplicated most airlines allow flying up to the 36th (domestic flights) and 35th (international flights) week of gestation. Unless the fetal oxygen supply is already impaired at ground level due to an underlying disease, flying does not pose a risk of fetal hypoxia. Radiation exposure during a long distant flight is low compared to the average annual exposure dosage, but the risk of thrombosis is increased. Altitudes up to 2,500 m pose no problem. Sufficient time to acclimatize must be taken when travelling to high altitudes and exercise kept to a minimum. Scuba diving is contraindicated. Since only a few drugs are completely safe during pregnancy a thorough risk/benefit evaluation is mandatory. Treatment of infections can be considerably complicated, but any necessary treatment should not be withheld because of the fear of potential fetal injury. Good knowledge of local medical resources is essential before travelling. Several personal protective measures minimize the risk of infection: food and water precautions, protection from insect bites and avoidance of crowds, unsafe sex and, if need be, freshwater. Many vaccinations are recommended for travellers. However, live vaccines are contraindicated in pregnant women because of theoretical considerations. Exceptionally a yellow fever vaccination may be given after the first trimester. Killed, inactivated or polysaccharide vaccines can be given after the first trimester after a thorough risk/benefit evaluation. Because of the potentially devastating effect of malaria to the mother and the child, travelling to endemic malaria regions should be avoided. If the risk of infection is high chemoprophylaxis with mefloquine is indicated. In low-risk countries mefloquine, in South-East-Asia artemisinin derivatives should be given as stand-by treatment.