A few weeks ago I suffered through dengue fever…again. This is either the second or third time I’ve had the virus in Cambodia, and I’m sharing my experiences here both to garner sympathy and as a cautionary tale.

Getting dengue fever in Cambodia — not a good buzz.

Every time I have had dengue, despite showing similar symptoms, it has hit me differently. Last month I was feeling fine when all of a sudden I got a terrible lower backache that I attributed to sitting in front of a computer for too long. But a few hours later I started vomiting, and shortly after that was running a fever, getting the chills, and feeling like electric shocks were running up and down my body. I went from feeling dandy to being in the the grips of a serious bout of dengue in just a few hours. For two days I thought I was going to die, but it disappeared just as quickly as it came on — my fever subsided on the third night and I went back to feeling normal, although very tired and run down.

When I had dengue almost a year ago to the day (it’s a rainy season virus) I wasn’t sure if I was even sick for the first few days. My partner had dengue and I thought perhaps I had a sympathetic case because I was fatigued and unhappy. It took a couple days before I started running a fever, but then all of the typical symptoms came on. This time I got a nasty-looking rash, and my hands and feet itched terribly. They say the dengue rash is not itchy, but that’s not exactly true because the rash gives you feeling of tightness in your fingers that demands attention; I dealt with this by applying hand cream every few hours. Once the rash subsided I was rewarded with the most gratifying scratching ever — you have to experience it to understand. My second bout of dengue was very mild and although it was uncomfortable, I just sat around watching TV for a few days.

The first time I had dengue, in 2011, was the worst, but it was never clear if it was actually dengue. I got bitten by a mosquito in my apartment, and from the same bite I got a staph infection and possibly dengue. Because the staph infection was so bad, at first I attributed my fever and aches to that, but after being on penicillin for a few days my fever didn’t go away, and I had terrible body pain and chills, pain behind my eyes, and the same itchy and hands and feet that I later experienced with confirmed dengue. I couldn’t look at a computer or TV because the light hurt my eyes so badly, and I lost 14 pounds in 10 days from not eating. The blood test I had didn’t reveal abnormally low white blood cells, which could have been because of the staph infection, which raises the white blood cell count.

Getting a blood test with the first stages of the dengue rash — it got much more unpleasant looking.

Which brings me to my next point — the tests for dengue suck. Some doctors will only give you a blood cell count test which means they diagnose dengue by a process of elimination. More often these days they will do a blood test that looks for the dengue antibodies, but depending on which type of test you get, dengue won’t show up unless you are in a certain window — for example, the most common test will only show the virus in the first few days of the acute stage, which means if you wait a few days to get tested it might not show up. The antibody test that is supposed to show whether or not you’ve had dengue before is also not always accurate; people who have had confirmed cases of dengue report that they haven’t shown the antibodies for previous infections when they get it a second time.

Because my symptoms weren’t bad the second time and I was almost certain it was dengue (because my partner already had it) I went directly to a lab and asked to be tested — the cost was less than $10. However, if you have more severe symptoms it’s best to go to the doctor so they can rule out other diseases or problems. For example, appendicitis can have similar symptoms.

For most people, getting dengue is no big deal. It’s like a really bad flu. For others it’s just a mild flu. The best way to treat dengue is with regular doses of paracetamol/acetaminophen and by drinking lots, and I mean lots, of water. Don’t take aspirin or ibuprofen because they are blood thinners and dengue screws up your blood anyway, and you don’t want to be at risk for plasma leak or hemorrhage. For the most part, if you keep yourself hydrated you probably won’t need to go to the hospital, and will just need to ride out the fever.

However, once one enter the critical stage of dengue, which is a few days in when the fever subsides, a small percentage of people develop dengue hemorrhagic fever which is much more serious. If you see any evidence of this — bloody nose, tarry stool, large bruises or any type of excessive bleeding — head to the hospital immediately. This is when having a good health insurance or travel insurance policy pays dividends.

While dengue is not very dangerous, dengue hemorrhagic fever is, and needs to be watched for carefully. There are four and possibly five strains of dengue and once you get one you are immune to that strain, but more susceptible to dengue hemorrhagic fever if you later contract one of the other strains. For this reason it’s important to get your blood tested every few days to make sure your white blood cell count hasn’t dropped precipitously low.

In the final kick up the ass, there are many post-dengue symptoms including fatigue, depression, and hair loss. Most of the post-dengue symptoms only last a few months, but one study I read says they can last up to two years. A long-term expat advises, “don’t make any big life decisions in the three months after dengue,” and I think that’s good advice to follow.

I will say that dengue is horrible, but the range of how horrible it is is very, very, large, with some people praying for a swift death and others just feeling under the weather. Nevertheless, it’s good to practice good mosquito bite prevention, a precaution that most expats tend to ignore. Mosquitoes transmit a host of diseases in addition to dengue in Cambodia (and Zika is surely on its way back with the Olympic athletes). Wear mosquito repellent and long pants and sleeves whenever possible, and offer lots of sympathy to your friends and neighbors that come down with dengue.