Women are prone to urinary tract infections during travel. Infection can be caused by a number of factors, including dehydration, less frequent urination due to a lack of convenient toilets, fewer available facilities for hygiene, and an increase in sexual activity. Women of all ages should be taught the symptoms of a urinary tract infection and how to treat it with oral antibiotics and a urinary analgesic agent (see Table 24.16).
Measures to prevent urinary tract infections include instructions for female travelers to stay well hydrated and to urinate, whether or not the bladder is full, wherever there is convenient access to a public toilet. Some women find the squatting position, necessary to make use of a pit toilet or the outdoors, to be a difficult maneuver. Women should consider attire that would facilitate this stance and add some privacy, such as a loosely cut skirt. A number of plastic and paper funnels have been designed to assist women to urinate in the standing position. This method requires some practice. The funnels are especially useful in extremes of cold weather and altitude when a woman might not want to wear a skirt or pull down her pants.
To maintain hygiene in unexpected places it is important to carry a supply of paper tissues or toilet paper and some packets of premoistened towelettes.
If an older woman has a problem with stress incontinence or bladder control she should consult with a physician specializing in female urinary tract problems prior to her trip. For minor problems women can be taught to do pelvic floor exercises and advised to take a supply of panty liners. Older women may experience vaginal dry-ness and urinary frequency or urgency without dysuria. Recent data suggest that estrogen vaginal cream, vaginal rings or even an oral contraceptive pill inserted intra-vaginally may decrease urogenital dryness and frequency symptoms (Nash et al., 1999; Gass and Rebar, 2000; Rioux et al., 2000).
Traveling tends to promote a change in a woman's vaginal ecosystem that may result in increased vaginal discharge and/or itching. One of the most common causes of vaginitis is Candida albicans. This organism usually causes a thick cottage cheese discharge with vulvar and vaginal itching. The risk of yeast vaginitis is greater when doxycycline is used for malarial prophylaxis or other antibiotics are used for the treatment of travelers' diarrhea, bronchitis or urinary tract infections. Several intravaginal creams and suppositories are available over the counter (see Table 24.16). Due to the messiness of vaginal creams, some women prefer to use an oral treatment such as fluconazole (Diflucan). Other women prefer the creams, as they help with local itching. Both should be included in the travel medicine kit. A mild hydrocortisone cream may also be included for vaginal itching.
Another common cause of vaginitis is bacterial vagino-sis. This is caused by overgrowth of the bacteria in the vagina. The discharge is usually more of a grayish color and has a fishy odor. Bacterial vaginosis is treated with metronidazole or clindamycin vaginal cream or tablets.
Women should be taught self-diagnostic skills and given the appropriate treatment to include in her medical kit. Even if a woman has never had a vaginal infection before she should be prepared for this possibility, especially during extended trips. Women should be advised to seek medical evaluation if the symptoms do not improve with self treatment.
If a woman traveler has a new discharge and pelvic pain following a new sexual encounter she may have a sexually transmitted disease and should be evaluated accordingly.
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