Check out wikipedia dysentery. It happens around population centers.

In adults, dysentery caused by bacteria usually subsides spontaneously.

I assume that the OP is thinking about healthy adults, not young children and elderly. Also in a remote location, i.e. somewhere where locating water is necessary, and a filtration system needs to be small.

IE Back country!!! Where water is pure and moving. Not in delta regions, along slow moving rivers, towns and cities in LDCs.

normal flora

normal flora won't do you much good in the face of Giardia............

or numerous parasitic, water-borne infections common in under-developed countries.

A filtration step to remove large particulates, followed by use of the Steripen, would seem to me to be a reasonably effective treatment, on the effectiveness vs. hassle scale

yes

but each person's normal flora is different depending on their enviroment

Does D75 actually ever get out?

Until recently you could get away with this advise but Gardia (an ameobic source) affects many water supplies in most parts of the US, be it close to civilization or as far as you think you can get. Try it, you'll love it. Myself, have had it once and I'll pass (got it when I was on a light and fast one day ascent when I found out the normal descent was damaged by rockfall and the alternate descent added 20+ miles to it so I ended up drinking out of various water sources in the Sierra backcountry)

In other countries, your body doesn't adjust totally. Often,they are just so used to it that they assume its a natural part of life. In Peru my partner assumed he was immune to it since he had been in country for many months (since he often lives there) but after drinking out of a stream where cows were defecating nearby I ended up carrying his backpack off the mountain since he was doubled over an literally spraying every couple of minutes.

When I was in Nepal only a few of us who were pretty anal about our water (myself, kurt, colby and a couple of guys from Romania) avoided some sort of stomach or digestive ailments.

In areas like Peru or Nepal, there really is no civilization or wilderness, cows and people are everywhere and most of their fecal matter is contaminated. (In Nepal, the vast majority of children both in the city and in the rural surroundings have Hep A due to contamination, as do they have tapeworms and ......)

Quote:

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In adults, dysentery caused by bacteria usually subsides spontaneously.

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Perhaps it would be appropriate to add "after weeks or months and misery and illness.

but each person's normal flora is different depending on their enviroment

True, but for most of us living in the developed world, drinking water and eating foods that are by and large free from significant amounts of potentially pathogenic microbes, "just drink the water" is a somewhat rash stance.

YVMV, but I'll take reasonable precautions to avoid a case of two-bucket syndrome

From, say, trieste to, um, ulan-bataar, I'd say there is little to no 'wilderness' as americans know it. just speaking from a little personal experience...

Chas is absolutely right. People, cows, sheep, horses, and everything else is coming and going and everywhere.

As for 'local adjustment', yeah right. The locals that can afford it all buy bottled water, the others get nasty disease and stink up the bathrooms.

My dad got giardia once. No thanks. Didn't kill him, but made him wish it had! Foulness in the extreme.

I use iodine in the backcountry, but I hate how long I have to wait. May look into one of these more modern solutions.

GO