Typhoid Fever: Symptoms, Causes, Diagnosis and Treatment — What You Need to Know
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Editorial note: This article is provided for educational purposes only. It is not medical advice. Always consult a qualified healthcare professional for diagnosis and treatment of any condition.
Quick Answer: What is typhoid fever and how is it treated?
Typhoid fever is a life-threatening bacterial infection caused by Salmonella enterica serotype typhi, most often picked up from contaminated food and water while traveling in Africa or South Asia. Antibiotics are the only treatment, shortening the fever and lowering complication risk. Vaccines and careful food and water habits reduce the chance of getting sick.
What the research says
A single typhoid conjugate vaccine dose protects children well. In a randomized trial in Nepal of 20,019 children aged 9 months to 16 years, blood-culture-confirmed typhoid fever occurred in 7 children who received the typhoid conjugate vaccine versus 38 who received a control vaccine — a vaccine efficacy of 81.6% (95% CI 58.8–91.8). Fever after vaccination was similar in both groups (5.0% vs 5.4%) (Shakya et al., The New England Journal of Medicine, 2019). This is a different vaccine from the two described in the U.S. section below.
No antibiotic has clearly beaten the others, and resistance is widespread. A review of treatment evidence notes that systematic reviews of randomized trials found no significant differences between antibiotics for enteric fever, that resistance has been described for every antibiotic class used (including ceftriaxone and azithromycin), and that choice should follow local resistance patterns. Extensively drug-resistant typhoid needs azithromycin and/or meropenem (Parry et al., Open Forum Infectious Diseases, 2023).
When Should You Seek Care for Possible Typhoid Fever?
Timing matters with typhoid fever, so it is important to know when to get medical care. See a healthcare professional right away if you think you might have typhoid fever. This is especially important if you — or someone you have close contact with — recently traveled to a place where the risk is high. If your symptoms are severe, go to an emergency room or call 911 or your local emergency number.
“See a healthcare professional right away if you think you might have typhoid fever. Before traveling to another country, find out where to call to get a list of healthcare professionals. In some places, that may be the closest embassy or consulate.” — source reference [1]
Your situation | What the sources recommend |
Symptoms of typhoid fever, or recent travel to a high-risk area | Call your healthcare professional promptly |
Severe symptoms | Go to an emergency room or call 911 / your local emergency number |
Planning travel abroad | Find out where to call for a list of healthcare professionals (in some places, the closest embassy or consulate) |
Recovering from typhoid fever | Take all antibiotic pills as prescribed; do not prepare food for others until cleared by your healthcare professional |
What Exactly Is Typhoid Fever?
Typhoid fever is a life-threatening infection caused by a certain strain of salmonella bacteria called Salmonella enterica serotype typhi. It affects millions of people each year worldwide.
The illness is rare in places where few people carry the bacteria. It is also rare in places that treat water to kill germs and manage human waste well. That is why typhoid fever is rare in the United States.
Most people in the U.S. who get typhoid fever get it during travel to other countries. Africa and South Asia have the highest rates of the illness.
Antibiotics can treat typhoid fever, but some antibiotics no longer work against the bacteria. This is called antibiotic resistance. Without treatment, there is a small chance of death from typhoid fever complications. Vaccines that protect against typhoid fever help lower the risk of getting the condition.
What Are the Symptoms of Typhoid Fever?
Symptoms are likely to start slowly, often showing up 1 to 3 weeks after contact with the bacteria.
Early Illness
Early symptoms may include a lasting fever that starts low and rises during the day. The fever can go as high as 104 degrees Fahrenheit (40 degrees Celsius).
Other early symptoms may include stomach pain, chills, headache, weakness and tiredness, muscle aches, and constipation or diarrhea. A rash may appear. People also may have a cough and may not want to eat.
Later Illness
A few weeks after symptoms start, the illness can cause complications in the intestines. Symptoms at this stage may include stomach pain and a swollen belly.
In some people, symptoms may return up to a few weeks after the fever goes away.
Symptom stage | What you may notice |
Early illness (1–3 weeks after exposure) | Fever that starts low and climbs through the day (up to 104°F / 40°C) |
Early illness | Stomach pain |
Early illness | Chills |
Early illness | Headache |
Early illness | Weakness and tiredness |
Early illness | Muscle aches |
Early illness | Constipation or diarrhea |
Early illness | Rash; possibly a cough or loss of appetite |
Later illness (weeks in) | Stomach pain from intestinal complications |
Later illness | Swollen belly |
After recovery | Symptoms may return up to a few weeks after the fever goes away |
What Causes Typhoid Fever, and How Does It Spread?
A strain of bacteria called Salmonella enterica serotype typhi causes typhoid fever. People who have typhoid fever — or the bacteria in their body — can shed the bacteria in their stool.
The bacteria can spread in water that is not treated to kill germs and in food that is not cooked, such as raw fruits without a peel. Drinks that may carry the bacteria include water, ice made from untreated water, and milk or juice that is not pasteurized.
People swallow the bacteria if it gets into food and water. Not washing the hands well after passing stool also can spread the bacteria.
Typhoid Carriers
Even after having antibiotic treatment, people who recover from typhoid fever may have the bacteria in their bodies for more than a year. Called chronic carriers, they no longer have symptoms of the condition. But they can spread it to others.
Chronic carriers may need treatment with antibiotics to prevent the spread of typhoid fever.
Related reading: Typhoid is one of several infections spread through contaminated food and water. See our guides to Salmonella Infection: Symptoms, Causes, Diagnosis, and Treatment, Traveler's Diarrhea: What to Eat, Drink, and Do Before Symptoms Start and Food Poisoning (Foodborne Illness): Symptoms, the 16 Common Causes, and How to Recover Safely.
Who Is at Risk of Getting Typhoid Fever?
Typhoid fever is a serious worldwide threat, especially to children. Africa and South Asia have the highest number of infections as well as regular outbreaks. But typhoid fever happens around the world, often spreading through travelers to and from high-risk areas.
If you live in a country where typhoid fever is rare, your risk is higher if you work in or travel to areas where typhoid fever is common, work in a lab that handles the bacteria or stores samples of it, or have close contact with someone who is infected or recently has been infected with typhoid fever.
Risk factor | Why it raises risk |
Traveling or working in areas where typhoid is common | Greater exposure to contaminated food and water |
Working in a lab handling Salmonella enterica serotype typhi or storing samples | Direct contact with the bacteria |
Close contact with someone infected or recently infected | The bacteria spreads from person to person via stool |
Children in high-rate regions | Africa and South Asia have the highest infection numbers and regular outbreaks |
What Complications Can Typhoid Fever Cause?
Typhoid fever complications may include an infection caused by gut bacteria spreading throughout the body, called sepsis, and bleeding in the intestines from holes — also called perforations — in the intestines.
Complications may also include changes in thinking, awareness and how you see what is around you, as well as a weakness in an artery caused by an infection, called a mycotic aneurysm.
These are life-threatening complications that need medical care right away. Learn more in our guide to Sepsis: Complete Guide to Symptoms, Causes, Risks, and Treatment.
How Is Typhoid Fever Diagnosed?
A healthcare professional may suspect typhoid fever based on your symptoms and your medical and travel history. Lab tests can confirm the diagnosis.
A healthcare professional tests a sample of blood, stool or urine for the bacteria. The lab uses the sample to try to grow bacteria. If bacteria grow, the lab checks the growth — called a culture — under a microscope for the typhoid bacteria. Sometimes a healthcare professional tests a sample of bone marrow.
There are other tests to diagnose typhoid fever. One test detects proteins the body makes to fight off bacteria in the blood. These are called antibodies. Another test looks for typhoid bacteria DNA in the blood.
Diagnostic test | What it looks for |
Blood, stool or urine sample | Bacteria grown in a culture and checked under a microscope |
Bone marrow sample | Typhoid bacteria (used sometimes) |
Antibody test | Proteins the body makes to fight off bacteria in the blood |
DNA test | Typhoid bacteria DNA in the blood |
How Is Typhoid Fever Treated?
Antibiotic medicine is the only treatment for typhoid fever. The medicine can help you get better faster and lower the risk of complications. Without treatment, you can have the fever for weeks or months.
The medicine you get may depend on how bad the illness is and where you picked up the bacteria. Sometimes one or more antibiotics do not work on the bacteria. Called antibiotic resistant, these bacteria make treating typhoid fever harder. Local resistance patterns are an important guide to the best choice (Parry et al., 2023).
Antibiotics That May Be Used
Fluoroquinolones. These antibiotics, including ciprofloxacin (Cipro), may be a first choice. They stop bacteria from copying themselves.
Cephalosporins. This group of antibiotics keeps bacteria from building cell walls. One kind, ceftriaxone, is used if there is antibiotic resistance.
Macrolides. This group keeps bacteria from making proteins. One type, azithromycin (Zithromax), can be used if there is antibiotic resistance.
Carbapenems. These antibiotics also prevent bacteria from building cell walls. Antibiotics in this group may treat serious typhoid fever that other antibiotics do not help.
Surgery
Surgery is another treatment. If your intestines or blood vessels are damaged, you may need surgery to repair them.
Treatment category | What the sources describe |
Antibiotics (the only treatment) | Get you better faster and lower complication risk |
Fluoroquinolones (e.g., ciprofloxacin) | May be a first choice; stop bacteria from copying themselves |
Cephalosporins (e.g., ceftriaxone) | Used when antibiotic resistance is present |
Macrolides (e.g., azithromycin) | An option when antibiotic resistance is present |
Carbapenems | For serious typhoid fever other antibiotics do not help |
Surgery | Repairs damaged intestines or blood vessels |
How Can You Prevent Typhoid Fever Before Traveling?
A vaccine can help protect against typhoid fever. You might get the vaccine if you live where typhoid fever is common, or if you plan to travel to a place where the risk is high.
The Two Vaccines Available in the United States
There are two vaccines in the United States. One is a single shot you get at least one week before travel; people age 2 and older can take this form, and it lasts two years. The other is four capsules you take by mouth every other day; people age 6 and older can take this form, and it lasts up to five years.
The vaccine does not completely protect you from typhoid fever. So in high-risk areas, follow the food-and-water guidelines below.
Prevention step | What the sources recommend |
Vaccination | Single shot (age 2+, at least one week before travel, lasts two years) or four oral capsules (age 6+, lasts up to five years) |
Hand hygiene | Wash hands often and well with hot, soapy water — before eating or making food and after using the toilet or changing a diaper; carry an alcohol-based hand sanitizer |
Safe drinks | Drink only bottled water or canned/bottled carbonated drinks, wine or beer; ask for drinks without ice; use bottled water to brush your teeth; try not to swallow water in the shower |
Safe food | Don't eat raw fruits and vegetables you can't peel — especially lettuce; to be safe, don't eat any raw foods; choose cooked, steaming hot foods over food stored or served at room temperature |
Don't Infect Others
If you are recovering from typhoid fever, you can help keep others safe. Besides washing your hands well and often, take all the antibiotic pills in your prescription exactly as your healthcare professional tells you. Do not make food for others until your healthcare professional says it is safe. If you are a food or healthcare worker, you may need to take a test to show that you have stopped shedding typhoid bacteria before you return to work.
How Should You Prepare for Your Doctor's Appointment?
Call your healthcare professional if you have symptoms of typhoid fever — very important if you or someone with whom you have close contact recently traveled to a place where the risk is high. If your symptoms are severe, go to an emergency room or call 911 or your local emergency number.
When you make an appointment, ask if there is anything you need to do before your visit. There may be ways to lower the risk of spreading the bacteria to someone else.
Make a list of your symptoms and when they began, ways you might have had contact with the bacteria (note any travel abroad, including the countries you visited and when), key medical information (other conditions being treated, all medicines, vitamins and supplements with doses, and vaccines you have had), and your questions for your healthcare professional.
Questions to ask include: What might be the cause of my symptoms? What tests do I need? Are there treatments? If I have other health conditions, how can I best manage them together? How long do you think it will take me to recover fully? When can I go back to work or school? Am I at risk of any long-term complications from typhoid fever? Be sure to ask all the questions you have.
Your healthcare professional is likely to ask whether anything makes your symptoms better or worse, whether your symptoms got better and then came back, and whether you updated your vaccinations before traveling.
Conclusion: Protect Yourself Before You Go
Typhoid fever is a serious, preventable illness that most Americans encounter only through travel to high-risk regions. The pattern is clear: contaminated food and water introduce the bacteria, antibiotics cure the infection — provided resistance has not blocked the medicine — and vaccination plus careful hand, food, and water habits keep the risk low. If you have symptoms after international travel, do not wait: contact your healthcare professional promptly and share your travel history, since it is the key that unlocks the right diagnosis.
Take the next step: Talk with your healthcare professional about typhoid vaccination at least a week before your next trip to a high-risk area, and review the food-and-water checklist in this article as you pack.
Frequently Asked Questions
1. What is typhoid fever?
Typhoid fever is a life-threatening infection caused by the Salmonella enterica serotype typhi strain of salmonella bacteria. It affects millions of people each year worldwide, especially in Africa and South Asia, and is rare in the United States.
2. How do you get typhoid fever?
You swallow the bacteria through contaminated food and water — untreated water, ice made from untreated water, unpasteurized milk or juice, and raw food that cannot be peeled. People with the bacteria shed it in their stool, so unwashed hands can also spread it.
3. Is typhoid fever common in the United States?
No. It is rare in places where few people carry the bacteria and where water is treated and human waste is managed well. Most people in the U.S. who get typhoid fever get it during travel to other countries.
4. Where in the world is typhoid fever most common?
Africa and South Asia have the highest rates of typhoid fever, with the highest number of infections and regular outbreaks.
5. How long after exposure do symptoms start?
Symptoms usually start slowly, often showing up 1 to 3 weeks after contact with the bacteria.
6. What does typhoid fever look like?
Early symptoms include a lasting fever that starts low and rises during the day — reaching as high as 104°F (40°C) — along with stomach pain, chills, headache, weakness, muscle aches, constipation or diarrhea, and sometimes a rash, cough, or loss of appetite.
7. Can typhoid fever cause a fever of 104 degrees?
Yes. The fever can go as high as 104 degrees Fahrenheit (40 degrees Celsius).
8. Does typhoid fever cause diarrhea or constipation?
Both can occur. Early symptoms may include trouble passing stool (constipation) or loose stools (diarrhea).
9. Can typhoid fever symptoms come back after you recover?
Yes. In some people, symptoms may return up to a few weeks after the fever goes away.
10. What are the complications of typhoid fever?
Complications may include sepsis, bleeding in the intestines from perforations, changes in thinking and awareness, and a mycotic aneurysm. These are life-threatening and need medical care right away.
11. Is typhoid fever curable?
Yes. Antibiotic medicine is the only treatment for typhoid fever. It helps you get better faster and lowers the risk of complications. Without treatment, you can have the fever for weeks or months.
12. Can typhoid fever be fatal?
Without treatment, there is a small chance of death from typhoid fever complications. Its serious complications are life-threatening and need medical care right away.
13. What antibiotics treat typhoid fever?
Four groups are described in the sources: fluoroquinolones (such as ciprofloxacin, which may be a first choice), cephalosporins (such as ceftriaxone, used if there is antibiotic resistance), macrolides (such as azithromycin, used if there is resistance), and carbapenems (for serious cases other antibiotics do not help). Local resistance patterns guide the choice.
14. Why do some antibiotics not work for typhoid fever?
Some antibiotics no longer work against the typhoid fever bacteria. This is called antibiotic resistance, and it makes treating the illness harder.
15. Is there a typhoid fever vaccine?
Yes. Two vaccines are available in the United States: a single shot at least one week before travel (age 2 and older, lasts two years) and four capsules taken by mouth every other day (age 6 and older, lasts up to five years).
16. Does the typhoid vaccine protect you completely?
No. The vaccine doesn't completely protect you from typhoid fever, so food and water precautions are still necessary in high-risk areas.
17. What should you eat and drink while traveling in a typhoid-risk area?
Drink only bottled water or canned or bottled carbonated drinks, wine or beer. Ask for drinks without ice. Eat cooked, steaming hot foods, and avoid raw foods you cannot peel — especially lettuce. Use bottled water to brush your teeth and avoid swallowing shower water.
18. Can you get typhoid fever from ice?
Yes. Ice made from water that is not treated to kill germs may carry the bacteria. The sources recommend asking for drinks without ice in high-risk areas.
19. Can someone spread typhoid fever after they recover?
Yes. People who recover may carry the bacteria in their bodies for more than a year. Called chronic carriers, they no longer have symptoms but can spread the infection to others and may need antibiotic treatment to prevent the spread.
20. Should food workers be tested after typhoid fever?
If you are a food or healthcare worker, you may need to take a test to show that you have stopped shedding typhoid bacteria before you return to work.
21. When should I see a doctor about typhoid fever?
See a healthcare professional right away if you think you might have typhoid fever, especially if you or a close contact recently traveled to a high-risk area. If your symptoms are severe, go to an emergency room or call 911 or your local emergency number.
22. Who is at higher risk of typhoid fever?
People who travel to or work in areas where typhoid is common, people who work in labs handling the bacteria or storing samples, people with close contact with someone infected or recently infected, and children — the illness is a serious worldwide threat especially to them.
23. How is typhoid fever tested for?
A healthcare professional tests a sample of blood, stool or urine to grow the bacteria in a culture and check it under a microscope. Sometimes a bone marrow sample is tested. Antibody tests and typhoid bacteria DNA tests in the blood are also used.
24. Can typhoid fever damage your intestines?
Yes. A few weeks after symptoms start, the illness can cause intestinal complications, including bleeding from perforations in the intestines. Surgery may be needed to repair damaged intestines or blood vessels.
25. Will I need to stay home from work or school with typhoid fever?
Your healthcare professional will advise you. Among the questions the sources suggest asking at your appointment: “When can I go back to work or school?”
References
Mayo Clinic Staff. Typhoid fever - Symptoms and causes. Mayo Clinic. December 24, 2025. https://www.mayoclinic.org/diseases-conditions/typhoid-fever/symptoms-causes/syc-20378661
Mayo Clinic Staff. Typhoid fever - Diagnosis and treatment. Mayo Clinic. December 24, 2025. https://www.mayoclinic.org/diseases-conditions/typhoid-fever/diagnosis-treatment/drc-20378665
Shakya M, Colin-Jones R, Theiss-Nyland K, et al. Phase 3 efficacy analysis of a typhoid conjugate vaccine trial in Nepal. The New England Journal of Medicine. 2019;381(23):2209-2218. PMID 31800986. https://doi.org/10.1056/NEJMoa1905047
Parry CM, Qamar FN, Rijal S, et al. What should we be recommending for the treatment of enteric fever? Open Forum Infectious Diseases. 2023;10(Suppl 1):S26-S31. PMID 37274536. https://doi.org/10.1093/ofid/ofad179
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