Make sure you are up to date with all necessary immunisations. All of these can be done at The Harley Street General Practice, with the rare exception. Ideally, you should book in to see one of our GPs as soon as you know you are travelling to see what is needed and plan a timetable for vaccination. But most can be administered on the day.

Some vaccinations need several weeks to be fully active or a course of injections may be required. A good source of independent travel advice telling you likely vaccination requirement on the web is www.fitfortravel.scot.nhs.uk.

We are also a registered Yellow Fever Vaccination Centre and so are able to administer this vaccine and give a mandatory certificate which is required for entry into some countries.

Malaria is widespread in tropical and sub-tropical areas of the world and is spread by the bite of an infected mosquito. Infection produces fever and, in some cases, complications affecting the kidneys, liver, brain and blood. Malaria can be fatal. Precautions should be taken if you are going to visit, travel through, or even just stop over in a malarial country.

Avoidance of mosquito bites is the single most important preventive measure, particularly with increasing resistance of the disease to drug treatment. This can be simply achieved by taking the following precautions:

• Use insect repellent, preferably one containing DEET (Diethyltoluamide)
• Keep your arms and legs covered with appropriate clothing (long trousers, sleeves and dresses) especially when out walking and around sunset and dawn when the infecting mosquitoes are most active
• Sleep in properly screened rooms and employ a “knockdown” spray to kill any mosquitoes in the room. Ideally use a mosquito net (which may be impregnated with insecticide) around the bed at night, ensuring that it has no holes and is well tucked in.

Malaria Prevention tablets are vital in some areas where the above measures, although still essential, are unlikely to give adequate protection on their own. Our GPs will advise you if anti-malarial tablets are required for where you are travelling to (i.e.in high-risk areas) and if so, which ones are recommended. Some are prescription only.

Even if you have taken the most appropriate tablets none of these anti-malarial precautions can give absolute protection. So if you develop influenza-like symptoms, especially associated with shivering/shaking attacks (rigors) while abroad, or even within a year of returning from a malarial area or after discontinuing prophylaxis, you should seek medical attention urgently. You should tell the GP of your recent travel to a malarial area.

This is a very common and troublesome complaint. If the diarrhoea is accompanied by persistent vomiting, a high fever or the passage of blood in the stools then prompt medical advice should be sought. Otherwise, ensure that you remain well hydrated by drinking plenty of fluids and avoiding any dairy products. Anti-diarrhoeals such as Imodium are useful to reduce the frequency of diarrhoea in the short term, but if symptoms persist beyond 3-4 days, again seek medical advice. Research has shown that most cases of travellers’ diarrhoea responds to two doses of Ciprofloxacin 500mg taken at an interval of 12 hours. Your GP may be prepared to prescribe this if your trip is 'high risk' and there are no contra-indications to you taking this medication.

Any diarrhoeal illness will result in significant loss of body fluids, partly from the diarrhoea itself and partly from the tendency to stop eating and drinking. It is vital to prevent dehydration by taking frequent small drinks of mineral water or by using oral rehydration salts such as Dioralyte.

The prevalence of many sexually transmitted infections is greater in many parts of the world when compared to the UK. You should regard casual sexual relationships as risky and take great care to avoid the potential for acquiring infection. Condoms are an absolute necessity and whilst substantially reducing the risk of sexually transmitted infection, they do not offer complete protection.

Many people are concerned about their personal risk of a DVT which is a clotting of the blood in a deep vein of the lower leg. If this occurs it usually causes pain, redness and swelling in the affected calf. Medical attention should be sought immediately, especially after a long air flight or other journey. Sometimes a DVT can be fatal if the clot breaks off and makes its way to the lungs where it can then affect the lungs’ ability to take in oxygen.

• Those in a higher risk category should see their GP before they travel and discuss prevention. This includes people with a personal or strong family history of thrombosis, smokers, those over the age of 65 and individuals who have undergone recent surgery (especially to lower limbs or abdomen). A history of cancer or heart disease may also be important. Also travellers who are obese, pregnant women and women taking oral contraceptives (particularly those who smoke) are at some increased risk.
• Some people in these "higher risk" categories mentioned above should discuss with their GP whether taking a small dose of aspirin before they fly (75mg) and wearing firm support stockings to reduce their risk is advisable.
• The personal entertainment available on many aeroplanes encourages us to stay rooted to our seats. However, try to exercise for 3 or 4 minutes every hour on long flights to ensure effective circulation of blood around the body.
• Too much alcohol, tea or coffee on flights causes dehydration which can also increase the risk of a DVT. Also, the air in a plane is very dry and the temperature warmer than we might normally have at home. It is very important to remain well hydrated during a long flight by drinking plenty of water or soft drinks.