Wed | Nov 20, 2019

Dear Doc | Pregnant with worms!

Published:Sunday | November 3, 2019 | 12:11 AM

Q Dear Doc, I am very shocked and embarrassed, and so would like your help. The easiest way to say this is that I am pregnant with worms.

I kept having itching to my bottom and thought it was piles, but one night on the toilet I scratched and felt something, and when I moved it and looked at it, it was a worm! I nearly died! I screamed and my boyfriend came, but by that time I dropped it. Extremely ashamed, I confessed to him what happened and we Googled it. I think it is a pinworm.

How could I have got this? Can this crawl and get to the baby? Can I take Zentel that I see advertised? I need help because now I think I can feel them crawling around back there, especially at nights.

 

A Yes, indeed, that can be frightening. Pinworm (Enterobius vermicularis) and whipworm (Trichuris trichiura) are two of the most common intestinal worm infections worldwide, with pinworm being the most common. It is seen most frequently among schoolchildren ages five to 10 years, and it is relatively uncommon in children less than two years old.

In terms of how you got them, that could be from many sources, and is usually best explained by the life cycle of the worm and the various means of transmission.

The life cycle and transmission of the pinworm is simple. The cycle begins with eggs being deposited by pregnant adult female worms in the perianal folds of humans. We then infect ourselves by scratching the perianal area and transferring the eggs to our mouth with contaminated hands.

Person-to-person transmission can occur by eating food touched by contaminated hands or by handling contaminated clothes or bed linens. Infection may also be acquired via contact with surfaces such as curtains and carpeting that are infected with eggs. Eggs can also become airborne, inhaled and swallowed.

Following ingestion, eggs hatch and release larvae in our small intestines. The adult worms establish themselves in the gastrointestinal tract. Most infected individuals have a few to several hundred adult worms.

Pregnant female worms then migrate through the rectum on to the perianal skin to deposit eggs; this usually occurs at night.

Based on the above, most adults in families get it from their children; so if you have young children, please have them treated.

Regarding your question about it crawling to the baby, adult worms can migrate to sites away from the intestines, including the vagina. Pinworms cannot, however, hurt or infect your baby before birth, but they are uncomfortable.

Treatment of pinworms in pregnancy is usually reserved for patients with significant symptoms.

Hygiene measures

Strict hygiene measures can clear up pinworm infections without medication. The worm has a lifespan of about six weeks, therefore the strict hygiene measures needs to last that long. Everyone in the household has to adhere to strict hygiene. These measures will include:

- Washing all bed linen, pajamas, and any soft toys an older child sleeps with.

- Vacuum your carpets and mop your floors regularly.

- Clean every floor in your whole house, especially bedrooms and bathrooms. Your goal is to get the eggs out of your carpets and off your floors. Pinworm eggs can live two to three weeks outside the body.

- Clean surfaces in the kitchen and bathroom daily, especially faucet knobs and the toilet flush handle.

- Do not shake things that may have eggs on them, such as clothing, underwear, pajamas, bed linen or towels.

- Do not eat in the bedroom. There is a risk of swallowing eggs that have shaken off the bed linen.

- Make sure everybody’s fingernails are cut short, and they wash under their nails with a nail brush daily.

- Teach any older children to wash hands thoroughly after going to the bathroom and before eating.

- Always wear tight-fitting underwear (not boxer shorts for your partner), and change your underwear every morning.

- Everyone in the household needs to thoroughly soap and rinse their rectum and genital areas.

- Do not share towels or rags. Wash bath towels and rags after each use.

- Airborne eggs can theoretically land on your toothbrush. Keep toothbrushes in a closed cabinet and/or rinse them well before each use.

You should see your doctor to ensure that you are not a candidate for medical management. In the event that you will require medication, pyrantel is favoured over albendazole (Zentel) for treatment of pinworms in pregnant women.

Reinfection is common, despite effective treatment, so it is advised that everybody in the household be treated at the same time. Additionally, still adhering to the above hygiene measures are also helpful for reducing reinfection.

deardoc@gleanerjm.com