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. katie

    Yesterday my daughter said she seen a little skinny white worm in her stool of course I freaked because I’ve seen this befor but I also have a dog so I checked my dogs stool there was a little white worm I now understand dogs can’t get pinworms so any ideah what this is… my dog and daughter sleep together… well did not now…. plz help

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  2. Rim

    I have my daughter (6 Years) She is suffering from Pinworm. Diagnosed after my wife and I picked a worm to drs and did the lab analysis. Actually every 2 months (after 2 courses of Vermox interval 15 days) she gets back the worm in the vulva. I believe she had Pinworm in vagina and that Vermox won’t help! How to confirm diagnosis and how to treat? (she complains of itching on these nights)

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  3. kiarrah

    I’m twelve and have pinworms they are so uncomfortable

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  4. Kelly

    And if I did give her already when there were no worms. Because I don’t any any worms. Would that medicine hurt my child’s health? Like liver and other? I am very concerned and please me give your advice :(. Thank you so much Dr.

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  5. Kelly

    Dr prescribed one dose 200 ml albenza for my toddler 18 month old and 19 pound. Is it safe for my children? I was reading it says they don’t usually give children under 2 years old.

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  6. Lauren

    I am an 11 year old girl and I’ve had pinworms twice. I got medication for it the first time and had leftover for the second time. Now I have new pinworms and no more medication. I don’t want to tell my mom again because then another doctors appointment or something. And then we will use MORE money on medication. I have a few questions. Do they just go away automatically? If so how long will it take? And why am I getting pinworms over and over again?! I don’t touch my anus or vaginal area! I also wash my hands and trim my nails! Please help!

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    • Lauren, you sound like a very thoughtful and responsible girl. In the US, the over-the-counter medicine Pyrantel pamoate (which comes in brand names like Pamix, Pin-X, or Reeses Pinworm Medicine) is the most frequently used pinworm remedy because it is cheap and available without a prescription and works almost all the time, if two doses are given two weeks apart.

      Even with effective treatment, getting reinfected is very common. Treating the whole household at the same time can help prevent this. This is also a good time to wash all the bedding. (The hand washing and trimming of the nails you are already doing also helps).

      Without treatment, the adult pinworms live about 2 or 3 months. It’s possible for this to go away on its own. On the other hand, because each adult female worm can produce 10,000 or so eggs, pinworms can keep going and going unless treated.

      There are other things that can cause anal itching besides pinworms, so it’s best to not ignore a recurring problem.

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  7. Cynthia

    I dont know if i have pinworms… Im scared to tell my mom… (Just letting you know im a girl…) i found out today and im scared

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    • Cynthia

      I really freaked out someone please help me

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    • I know pinworms seem pretty gross and scary, but the good news is, they can be easily treated with a prescription from a doctor. Telling your mom will likely be the hardest part, but you need to talk to her to get help. If it feels too hard to say, write it down and give her the note. Try something like this, “Mom, I’m scared. I think I might have pinworms. I think I need to go to the doctor. I know I didn’t do anything wrong to get them, but it feels scary to me. That’s why I’m writing this note. Please help.”

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  8. not saying

    Im 11 years old and I found out I have pinworms, but I’m too embarrassed to tell my parents. I’ve hinted once saying my but was itchy and stayed up trying to get it not itchy, but the topic has never come up. What should I do?

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    • I totally understand that this feels embarrassing, but pinworms are pretty common. You do need your parent’s help to deal with the issue. I suggest you pull your mom or dad aside and tell them what’s up. Simply say, “I’m embarrassed and I need your help. I think I have pinworms and I need to see a doctor.”

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  9. Maya

    So I know I have pinworms, I have seen the little white wiggling threads and it itches like crazy. I’m 16, I’m wondering first of all if its normal for someone my age to get this. I was also wondering if I can pick up the medication over the counter instead of going to my doctor. I am hygienic so I was wondering how I got this? I work with kids?

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  10. Kristen

    My 2 yo has just been diagnosed with pinworms. I have a 5 yo in kindergarten. The eldest has, in the past, complained of itchiness around the anal area, but I did the middle of the night check and nothing. Now that the 2 to has a confirmed case I assume the eldest does too and we just didn’t see them yet.

    My question is should I notify my kindergarteners school? They will usually send home notes of notification when a child has come to school with a confirmed contagious illness like influenza, strep, or lice. And then maybe signs to look for.

    I feel like as a parent information is power, but not sure if classmates should be concerned. Sounds passable enough to be alarming to her classmates moms to me.

    Thanks for the information, when I found out I felt like I didn’t keep my child clean despite being an obsessive hand washer and sheet changer. But this makes me feel more at ease that those are helpful practices, but it’s no guarantee we will avoid this icky situation.

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    • Hi Kristen,

      As a mom, I think it would be great to inform your five year olds’ kindergarten teacher or the school nurse. The school no doubt has a policy about pinworms because they are common. She or he will know what to do from there.

      Hope that helps!
      MsGreene

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  11. Barb

    What does it mean my “my comment is awaiting moderation”?

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    • Hi Barb,

      That’s a great question. It means your comment is waiting for a live person to read it to make sure it’s not Spam. Once that has been determined, your comment will be posted to the site and anyone can respond.

      I just read your previous comment. I’m so sorry for what you’re going through. Hope others with real life experience can chime in and help.

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  12. Barb

    My sister and roommate have pinworms and live in a house I am responsible for. They say they are airborne, on the floor in the vacuum, everywhere!!!

    How long could it take for the last possible egg to die?

    Will the house ever be clean of pinworms?

    Does bleach, hot steam, or something else kill worms & eggs?
    Could fly tape catch airborne eggs? Are worms airborne?

    They’ve gone to a motel! Will they contaminate the room???!!!
    If so how would the motel cure infestation?

    Help!! Is there a cleaning protocol for the house & linens, clothes? What else could possibly need heavy cleaning besides the bathroom?

    They stayed three nights at another house. Is that house infected?

    My sister asked for $498.00 for three or four doses of a medicine she called “a poison”. Is that for real? Are there other meds. that cost less and just as effective?

    anything else to know? I haven’t found anywhere that give the really big picture of cleaning the environment to abate the numerous cycles of the pinworms life. Thank you for you help.

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  13. 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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  14. 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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  15. 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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  16. 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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      • Camille

        Hey, I am 14, I recently found out I have pinworms, i told my mom she was freaking out because she’s never heard of it. We went to the doctor and he said that anyone can get and and all you need to do is get medicine, (over the counter is available) and they should die.

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  17. 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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  18. 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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    • Lauren

      If your baby has them you would see them in her feces. And just ask your 7 year old and partner if they have them.

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  19. 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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  20. 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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  21. 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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