After you read this, you will probably think about it every time you go to bed, and I apologize, but this is a parasite that is more frequent than anyone realizes, and it can be treated, just an awkward one to talk about!  The worms are actually pinworms, which are also known as thread worms or seat worms, and they are a type of roundworm (nematode) and the medical term when you are infected with pinworms is an enterobiasis.  The CDC estimated that there is a 12% infection rate (adults and children) in the US yearly but the rates in India are 61%, UK 50%, 39% Thailand, 37% Sweden, 29% Denmark.  So, when in the US it isn’t a huge fear, but it is easily transmitted from person to person and with the amount of traveling that occurs, the numbers of infections can easily increase in the US.  And, it is the highest worm infection in the US; it is highest transmission rate is between school age children at school and through daycare centers, etc.

What is it?
It is a parasitic infection that lives in the human GI tract; their entire life cycle takes place within our bodies!  A worm hatches in the duodenum (the beginning of the small intestine) and then the migrate towards the colon in which time they molt twice and become adults.  They mate in the ileum (last part of the small intestine) and the females usually then live in the cecum (beginning of the large intestine), ileum, appendix, and ascending colon, whilst the males die and are passed in your poop.  They live off of your poop in the colon.  And they start laying eggs five weeks after initial ingestion of the worms; the female worms come out of your anus and lay their eggs so that the eggs can get oxygen and then they die.  They usually go to lay eggs when you are resting, so bedtime is the optimal time; you can feel itchiness in/around your anus, and sometimes it keeps people up (After I saw my first infection, I was obsessed that I had them, I didn’t, but every time I went to bed I had myself convinced that my butt was itching and it was bug related….nope, just psychosomatic!!)

Symptoms:
-Itchiness around the anal area along with difficulty sleeping and irritability
-nervousness
-restlessness
-weight loss (associated with loss of appetite)
-Vaginal itching for women (if the infection is severe and the worms are near the vagina)

How is it transmitted?
 The eggs are super sticky and are transmitted to others through these eggs being transferred.  They can get under your fingernails from itching the anus, and transfer onto your bed linens or pajamas, and go to your partner/bed mate from there.  It can be transferred form your hand/fingernails through not washing your hands and nail biting, so there is an oral transmission.  As well, when you are making your bed, shaking out the duvet (for example) the eggs can fly into the air and be inhaled.  They can also be easily transmitted due to improper hand washing after using the bathroom, and the eggs can stick onto any surface, and whomever is the lucky person to touch it next, can get the parasitic infection, which is why children are at such risk AND why households are usually infected, not just one person at a time.

These are some pinworms around a patients anus:

mtherald.com/anal-itching-pinworm/

How are they diagnosed?
At times, the female worms can be seen by the naked eye exiting the anus (I am not sure who you have stare at your anus while you sleep at night- that seems like a ridiculous diagnostic “test” but I guess if you are too embarrassed to go to see an HCP for your itchy butt?)
The other test, which is done more frequently, is that you put a piece of double sided tape around your anus, go to sleep, take the tape off in the morning as soon as you wake up, put it in a bag and bring to your HCP- if there are no visible worms, either worms can be seen under a microscope OR the eggs will be present.

Treatment:
*All household members need to be treated at the same time
-Vermox (Mebendazole)is an oral medication that is taken one pill orally and it may be repeated a week later for severe infections.
-Albenza (Albendazole) which you usually take twice a day (orally) for four weeks, then off for two weeks and you will need to repeat this 3 times.
-Pyrantel Pamoate (Pin-Rid, Pin X) which is OTC (over the counter) after confirmation by an HCP that you have the infection. Usually you take the liquid oral medication once but you should talk to your HCP if it doesn’t relieve symptoms because they may have you take it again OR change the medication.
-Also, wash all linens, undergarments, pajamas, and stuffed animals/blankets (for children) in HOT water DAILY until the infections are gone (usually 7-10 days from initial treatment start), vacuum your home to suck up any possible scattered eggs, and clean toys (for dogs and children)/bathroom/kitchen with a diluted bleach to kill off the eggs, as they can live on surfaces for three weeks.

Prevention:
Good hand washing is the key to prevention (including under the nails) and try not to bite your nails (I know, easier said than done!)  and bathe daily.  Also, encourage your children to wash hands frequently, and not to scratch their bottoms, even if they are super itchy!!

I hope knowing this info wards off the worms, and if not, you know what to do 😉 Also, I apologize again if you think about these creepy crawlies when hitting the sack tonight!

Yours in Good Health
B