So about a third of patients with pinworms are asymptomatic
but two-thirds will have symptoms including anal and perineal itching that is always worse at night.
These patients are gonna have continuous scratching and that can break down the skin
and this is where we get secondary bacterial infections
because remember, we're all covered in billions of bacteria.
So we get a breakdown in skin and that bacteria can enter.
Patients will have insomnia because they're up all night with the scratching and they're restless.
They may have loss of appetite, weight loss, and irritability.
And we sometimes see urinary incontinence.
So when examining a patient you suspect might have pinworms,
you need to collect a full health history.
You're also going to check your patient's vital signs.
Next, you'll check their cardiac and respiratory status, and you'll do a full GI exam.
Remember, these worms can migrate so you're also gonna check their GU system.
And finally, you're gonna do a dermatologic exam of their perineal and perianal regions.
So how do we diagnose pinworms?
Well, we need to try to find the eggs and these are visible by microscope.
You can also sometimes see adult pinworms. This is the tape test.
This is where you apply clear tape to the anal area
and you try to capture some eggs to look at under the microscope.
You can repeat this test in a few days if it's negative.
Rarely, the eggs are gonna be deposited in the intestine
and in fecal material only 5-15% of the time so stool studies are not reliable.
Pinworms can adhere to the stool but not always.
Adult pinworms can be seen on a colonoscopy.
How do we treat pinworms?
This requires medication and the frustrating part for patients is reinfection is frequent.
And we treat this with albendazole and mebendazole.
Total elimination in the household can require repeated doses of medication for up to one year.
The medication is gonna kill the adult pinworms
but not the eggs so as they mature and go through the cycle, the patient needs to re-treat in 2 weeks.
Asymptomatic patients, often young children, can serve as reservoirs for these worms.
They don't have any symptoms and so we really need to find this infection and treat the whole household.
Patients also need to know about cleaning their clothes, their bedding, and strict hand hygiene
because remember, these eggs are very sticky and they can get stuck to the hands and under the fingernails.
Complications of pinworms are uncommon.
We do see urinary tract infections in women as this can migrate up the urethra.
We see women with vaginal infections called vaginitis and this is also due to the pinworms.
These can migrate up into the uterus and this can cause endometritis
which is inflammation in the uterine lining and also infestation in the fallopian tubes
or other pelvic organs can happen.
In children, sometimes we see abdominal pain and this is from the significant worm burden.
And sometimes we see patients with weight loss.