Treating Pinworms

I have 3 children. In the last 2 years the same child has been infected with pinworms 3 times. We belong to a family medicine group. The first doctor elected to treat the whole family, but the 2nd and 3rd time I had to request this from different doctors. My question is, does the medicine to treat this infection hurt the family members who are not suffering from this gross infestation? Also, could the worms or eggs live dormant in my daughter or could she be a carrier? Or is there such a thing as a carrier?
Centreville, Virginia

Treating Pinworms

Dr. Greene’s Answer:

When I was a young boy, I used to have a creepy-crawler set. I delighted in making these little jiggling critters. I found particular joy in trying to make other people shudder when they saw the various worms and bugs that I had created. Although we adults often shudder at pinworm infections, most kids don’t have this same gut response.

The pinworm, or Enterobius vermicularis, is one of the most common parasitic infections of humans. Somewhere between 10% and 40% of children have pinworms at any given time (Pediatric Consult, Williams and Wilkins 1997). The infections are usually limited to children below the age of twelve.

The adult pinworms are white and measure less than one half inch long, with the diameter of a strand of thread. These tiny roundworms are quite complex. Like us, they have mouths, throats, and gastrointestinal tracts. Like us they have nervous systems. The females have a vagina, a uterus, and ovaries. The males have a testical, vas deferens, seminal vesicle, and ejaculatory duct. They eat, drink, pee, poop, and reproduce sexually.

The adult worms live in the colons (large intestines) of human children and apparently feed on human fecal matter.

When an adult male and female worm copulate, each female pinworm produces about 10,000 fertilized eggs. At night, the pregnant female migrates from the colon, out through the child’s anus and onto the skin of the buttocks. There she violently expels all of her eggs and then dies. Some of the eggs become airborne and land elsewhere in the child’s room, but the great majority of the fertilized eggs stay on the skin of the child’s buttocks. The eggs mature within six hours of being laid.

The adult worms and the eggs on the skin of the buttocks can cause intense itching in the child. When the sleeping child scratches, the eggs often get on the fingers and under the finger nails. If the child then sucks his or her thumb or otherwise brings his or her hand to the mouth (perhaps while eating breakfast), the pinworm eggs are swallowed. Usually they hatch within the small intestine and mature there. When they become adults they move to the colon where they take up residence. The entire life cycle lasts four to six weeks.

Occasionally the story goes a little differently. Sometimes a child can inhale airborne eggs and become infected that way. Every now and then the eggs will hatch on the skin of the buttocks, and the immature larvae will crawl back through the anus, up into the rectum and eventually arrive in the colon. Also, the eggs can hatch on the skin of girls and the larvae crawl into the vagina instead of the rectum. This happens in up to 20% of girls with pinworms (Nelson’s Textbook of Pediatrics, Saunders 1996). The vaginal pinworms usually die out with no outside help.

Most children with pinworms have no symptoms at all. In the same way that many bacteria live in our intestines without making us sick, pinworms can live happily in our intestines without causing any problems (Parasitic Diseases, Springer-Verlag 1982). Since the pinworm almost always stays in the gastrointestinal tract (or vagina), there is usually no systemic illness.

Some children, however, develop nighttime itching of the skin around the anus. For a small number of these children, the itching can be quite intense. The girls who develop vaginal pinworm infections often develop vaginal itching and sometimes a vaginal discharge. Attempts to link pinworm infection to bed wetting or grinding of the teeth have been unsuccessful.

Stool and blood tests are not very helpful in diagnosing pinworms. Seeing a worm clinches the diagnosis. Check your child’s skin with a flashlight during the night and first thing in the morning. Look for white, wiggling threads. If it’s not wiggling, it’s probably just lint. Occasionally a wiggling worm will be seen on the surface of a stool. Pinworms are so common that children with nighttime anal itching are often treated without any lab test at all. The classic diagnostic tool is to apply a piece of transparent tape to the skin near the anus first thing in the morning. This tape can then be attached to a glass slide and examined under a microscope for the presence of eggs. Your doctor can supply you with a pinworm lab kit, if necessary.

Treatment is with a single dose of an anti-pinworm drug such as Albenza (albendazole), pyrantel pamoate, or Vermox (mebendazole). Vermox comes as a chewable tablet. Most children and adults experience no side effects (use of these drugs in children less than two years old is limited). Hives or other allergic rashes have been reported only rarely. Very rare cases of convulsions have occurred.

This medicine kills the worms 95% of the time, but does not kill the eggs. Hence, retreatment in two weeks is a good idea. Girls with vaginal itching alone do not necessarily need treatment, since the problem will often disappear on its own.

Physicians disagree about whether or not to treat all family members. Often treating the infected child alone will get rid of the infestation. Anyone who sleeps with the child, or any family member or friend with itching should be treated. In stubborn cases, it’s a good idea to treat all family members regardless of symptoms.

It is certainly possible that your daughter is an asymptomatic carrier. In any case, reinfections with pinworms are quite common.

There are no differences in pinworm infections on the basis of race or socioeconomic class. Neither is pinworm infection evidence of poor hygiene. This is a very easily transmissible infection that is very common in children. It is easily spread at home, school, or day care (pets, though, have no part in the pinworm story). Since most kids experience no ill effects whatsoever, extreme measures to treat pinworms are not wise.

I usually recommend trimming the fingernails, scrubbing the hands (after awakening, before meals, and after toileting) and machine washing the bedding on the treatment day. These hygiene measures have never been proven to help at all, but they still seem like a good idea to me.

Although pinworms are like creepy-crawler bugs in that they are usually harmless (and seem worse than they are!), they are still a real nuisance! I hope you and your family will soon find relief from this bothersome problem.

June 22, 2011

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Anon

    I am 17 year old girl and have had pin worms before and was treated with over the counter medication, but they have come back. The medication I took before was two tablets one to be taken at the beginning of the month and one at the end of the month. Do I need to go to my GP or can I just get over the counter medication again and shower morning and night to wash the eggs away? So basically my question is: Do I need to go see my GP? Also, does having pin worms cause white discharge in the female area?

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  2. jacob

    PLEASE READ WHOLE PAGE!!!! I had pin worms for a very long time…..yet i couldn’t find a way to get rid of the, till i found this out, so has anyone out there eaten to muvh spicy food at once, then when you go to the bathroom it burns like heck….well one day i was at school, at lunch we have salads…so i got a salad with LOTS of jalapeno pepper slices on it ( i really like spicy foods )….and the next day when i went to the bathroom…yes it burnt like hell, but its been 2 months since i’ve had problems with the pin worms…..please consider trying….i hope this helps.☺

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  3. rahul

    I m 22 yrs old male ,some time when I go for Bathroom at night along with the things white tiny worms comes out might be 20 to 30 at a time ….no blood came ever but today’s when I was cleaning blood came out hat a bit from the anal ….what should I do I m getting tensed …plz。help

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    • jacob

      Lots of spicy foods…..when you use the bathroom it will burn the worms, and eggs..,trust me, it works,….good luck☺

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  4. kgomotso

    Hi I’m a 22 year old female and struggled with pinworms as a toddler. I have a 3 year old daughter who was diagnosed and treated for pinworms last year. A few days ago when I was sleeping I could feel something tingling down there and when I looked I couldn’t believe but find a small thin white worm. I thought that maybe my daughter was reinfected but just last night when I was sitting I felt the same tingling sensation from my vagina and when I looked it was a small white pinworm. I freaked out and I still am. I’m so embarrassed what could this be and could it be serious?

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    • Ashleu 123

      I have the same situation but my mum don’t believe me I’m 13 and im scared and upset that she don’t belevie me

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      • Juan

        It’s just pinworms, they commonly migrate to the vagina, just tell your parents you’ve seen little white worms in your anus.

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      • mina

        Make her take you to the doctor and maybe she’ll take them more seriously or show her the worms by doing the scoth tape test.

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  5. Scoobs

    Today I used the bathroom and there were really tiny worm looking things in my poop. They were like smaller than 1/4 of an inch and blackish. There were over 30. I saw 2-4 move. I don’t get this. What’s wrong with me? I have no bleeding or nothing wrong with me. Only thing is I realized I lost some weight. I’m 17. And I never had this before and I’m getting worried. Please give me some answers.):

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  6. Elizabeth widdop

    I have threadworm yet again. Maybe 4 to 5 times a year. I have a partner, a 7 year old girl and 4 month old girl. How will I know if the baby has them? And what treatment would I give her? Please can someone advise me?

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  7. alexis harper

    How do you get rid of pin worms if you can’t afford the treatment for you 3 year old daughter?

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    • Camille

      You can buy the treatment for less than $20 at your local pharmacy or online. That would be enough to treat an entire family.

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  8. Kelly

    Thank you for the informative article. My three year old son was recently prescribed Albenza after I discovered he had pin worms. He was treated 3 nights ago and still woke up last night crying and saying his “boo boo” hurt, which is how I had discovered that pinworms were the culprit. I plan on retreating him in two weeks, but should I be concerned that he was treated several days ago and is stillwwaking up crying? Will they not be completely killed until the second dose in 2 weeks?

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    • J love

      Hi kelly…
      Did you ever find out the answer to your question…
      Recently found my son had them… he was treated 3 dayd ago…and bwm I found anither one today. Im thinking maybe the dose wasnt high enough.. I read 400 is recomended he was given 200… should I wait til the second dose…. please let me know how things turned out.

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  9. Barbara Hogue

    I am 73 yrs old contacted pinworms 4 mo. ag, the medicine u suggested I have had they are back in 7 days, I sanitize everything, I live alone, why dod they keep coming back

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    • Barbara Hogue

      I am 73 live alone with my little dog, I contacted pinworms about 4 mo. ago have been treated with Albenza and Mebendazole, they come back in 7 days, I sterilize all the time what is the problem

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      • Ashleigh

        Treat your dog. It’s probably the culprit. And get some diatomaceous Earth and put it around the house. It’s great and so cheap.

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        • SARAH

          No, actually, if you have a dog and they have pinworms, they wouldn’t be the problem, because animal and human pinworms are a different thing.

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        • McKenzie

          Dogs can’t get pinworms, it is species specific meaning it is only found in humans. They are most likely coming back because the medicine only paralyzes the worms but doesn’t kill the eggs. I suggest taking 2 doses; once, and then another two weeks later.

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