{{About|the human infection with pinworms|the organism itself|Pinworm (parasite)}} {{Use dmy dates|date=March 2021}} {{Infobox medical condition (new) | name = Pinworm infection | image = Enterobius vermicularis.png | caption = Pinworm eggs (''Enterobius vermicularis'') | synonyms = Enterobiasis, oxyuriasis (Oxyuridae)<ref name=CDC2013Fact>{{cite web|title=Pinworm Infection FAQs|url=https://www.cdc.gov/parasites/pinworm/gen_info/faqs.html|website=CDC|access-date=16 October 2016|date=10 January 2013|url-status=live|archive-url=https://web.archive.org/web/20161015163604/http://www.cdc.gov/parasites/pinworm/gen_info/faqs.html|archive-date=15 October 2016}}</ref> | field = Pediatrics, Infectious disease | symptoms = Itchy anal area<ref name=CDC2013Fact/> | onset = 4 to 8 weeks from exposure<ref name=CDC2015Epi/> | duration = | causes = Pinworms (''Enterobius vermicularis'')<ref name=St2009/> | risks = Attending school and nursery, children<ref name=CDC2013Fact/> | diagnosis = Seeing the worms or eggs<ref name=CDC2013Fact/> | differential = | prevention = Handwashing, daily bathing in the morning, daily changing of underwear<ref name=CDC2013Fact/> | treatment = | medication = Mebendazole, Flubendazole, pyrantel pamoate, or albendazole<ref name=CDC2016Tx/> | prognosis = Non-serious<ref name=Rook2016/> | frequency = Common<ref name=CDC2013Fact/><ref name=Rook2016/> | deaths = }} <!-- Definition and symptoms -->
'''Pinworm infection''' ('''threadworm infection''' in the UK), also known as '''enterobiasis''', is a human parasitic disease caused by the pinworm, ''Enterobius vermicularis''.<ref name=St2009>{{cite journal|last1=Stermer|first1=E|last2=Sukhotnic|first2=I|last3=Shaoul|first3=R|title=Pruritus ani: an approach to an itching condition |journal=Journal of Pediatric Gastroenterology and Nutrition|date=May 2009|volume=48|issue=5|pages=513–6|pmid=19412003|doi=10.1097/mpg.0b013e31818080c0|doi-access=free}}</ref> The most common symptom is pruritus ani, or itching in the anal area.<ref name=CDC2013Fact/> The period of time from swallowing eggs to the appearance of new eggs around the anus is 4 to 8 weeks.<ref name=CDC2015Epi>{{cite web|title=Epidemiology & Risk Factors|url=https://www.cdc.gov/parasites/pinworm/epi.html|website=CDC|access-date=16 October 2016|date=10 January 2013|url-status=live|archive-url=https://web.archive.org/web/20161018082454/http://www.cdc.gov/parasites/pinworm/epi.html|archive-date=18 October 2016}}</ref> Some people who are infected do not have symptoms.<ref name=CDC2013Fact/>
<!-- Cause and diagnosis --> The disease is spread between people by pinworm eggs.<ref name=CDC2013Fact/> The eggs initially occur around the anus, and can survive for up to three weeks in the environment.<ref name=CDC2013Fact/> They may be swallowed following contamination of the hands, food, or other articles.<ref name=CDC2013Fact/> Those at risk are those who go to school, live in a health care institution or prison, or take care of people who are infected.<ref name=CDC2013Fact/> Other animals do not spread the disease.<ref name=CDC2013Fact/> Diagnosis is by seeing the worms which are about one centimetre long or the eggs under a microscope.<ref name=CDC2013Fact/><ref>{{cite web|title=Biology|url=https://www.cdc.gov/parasites/pinworm/biology.html|website=CDC|access-date=16 October 2016|date=10 January 2013|url-status=live|archive-url=https://web.archive.org/web/20161018213323/https://www.cdc.gov/parasites/pinworm/biology.html|archive-date=18 October 2016}}</ref>
<!-- Treatment --> Treatment is typically with two doses of the medications mebendazole, pyrantel pamoate, or albendazole two weeks apart.<ref name=CDC2016Tx>{{cite web|title=Treatment|url=https://www.cdc.gov/parasites/pinworm/treatment.html|website=CDC|access-date=16 October 2016|date=23 September 2016|url-status=live|archive-url=https://web.archive.org/web/20161018214051/https://www.cdc.gov/parasites/pinworm/treatment.html|archive-date=18 October 2016}}</ref> Everyone who lives with or takes care of an infected person should be treated at the same time.<ref name=CDC2013Fact/> Washing personal items in hot water after each dose of medication is recommended.<ref name=CDC2013Fact/> Good handwashing, daily bathing in the morning, and daily changing of underwear can help prevent reinfection.<ref name=CDC2013Fact/>
<!-- Epidemiology and prognosis --> Pinworm infections commonly occur in all parts of the world.<ref name=CDC2013Fact/><ref name=Rook2016/> They are the most common type of worm infection in Western Europe, Northern Europe and the United States.<ref name=Rook2016/> School-aged children are the most commonly infected.<ref name=CDC2013Fact/> In the United States about 20% of children will develop pinworm at some point.<ref name=St2009/> Infection rates among high-risk groups may be as high as 50%.<ref name=CDC2015Epi/> It is not considered a serious disease.<ref name=Rook2016>{{cite book|last1=Griffiths|first1=Christopher|last2=Barker|first2=Jonathan|last3=Bleiker|first3=Tanya|last4=Chalmers|first4=Robert|last5=Creamer|first5=Daniel|title=Rook's Textbook of Dermatology, 4 Volume Set|date=2016|publisher=John Wiley & Sons|isbn=9781118441176|page=33.13|edition=9|url=https://books.google.com/books?id=EyypCwAAQBAJ&pg=SA33-PA13|language=en|url-status=live|archive-url=https://web.archive.org/web/20171105195020/https://books.google.com/books?id=EyypCwAAQBAJ&pg=SA33-PA13|archive-date=5 November 2017}}</ref> Pinworms are believed to have affected humans throughout history.<ref>{{cite book|last1=Bynum|first1=W. F.|last2=Porter|first2=Roy|title=Companion Encyclopedia of the History of Medicine|date=2013|publisher=Routledge|isbn=9781136110368|page=358|url=https://books.google.com/books?id=gyidO-ZLdiYC&pg=PA358|language=en|url-status=live|archive-url=https://web.archive.org/web/20171105195020/https://books.google.com/books?id=gyidO-ZLdiYC&pg=PA358|archive-date=5 November 2017}}</ref>
== Signs and symptoms == thumb|upright=1.3|Two female pinworms next to a ruler. The markings are one millimetre apart. One-third of individuals with pinworm infection are totally asymptomatic.<ref name="burkhart2005p83832">Burkhart & burkhart 2005, p. 838</ref> The main symptoms are itching in and around the anus and perineum.<ref name="burkhart2005p83832"/><ref name="cook2009p151632">Cook et al. 2009, p. 1516</ref><ref name="gutierrez2000p35522">Gutiérrez 2005, p. 355.</ref> The itching occurs mainly during the night,<ref name="cook2009p151632"/><ref name="caldwell1982p3072">Caldwell 1982, p. 307.</ref> and is caused by the female pinworms migrating to lay eggs around the anus.<ref name="cook1994p11592">Cook 1994, p. 1159</ref><ref name="gutierrez2000p35522"/> Both the migrating females and the clumps of eggs are irritating, as well as the sticky substance that is produced by the worms when the eggs are laid.<ref name="caldwell1982p3072" /><ref>{{Cite journal |last=Russell |first=L. J. |title=The pinworm, Enterobius vermicularis |journal=Primary Care |year=1991 |volume=18 |issue=1 |pages=13–24 |doi=10.1016/S0095-4543(21)00913-1 |issn=0095-4543 |pmid=2011634}}</ref> The intensity of the itching varies, and it can be described as tickling, crawling sensations, or even acute pain.<ref name="cook1994p116022">Cook 1994, p. 1160</ref> The itching leads to continuously scratching the area around the anus, which can further result in tearing of the skin and complications such as secondary bacterial infections, including bacterial skin inflammation, and hair follicle inflammation.<ref name="cook2009p151632"/><ref name="gutierrez2000p35522"/><ref name="cook1994p116022"/> General symptoms are trouble sleeping, and restlessness.<ref name="cook2009p151632"/> A considerable proportion of children experience loss of appetite, weight loss, irritability, emotional instability, and bed wetting.<ref name="cook2009p151632"/>
Pinworms cannot damage the skin,<ref name=gutierrez2000p356>Gutiérrez 2005, p. 356.</ref> and they do not normally migrate through tissues.<ref name="gutierrez2000p35522"/> However, they may move onto the vulva and into the vagina, from there moving to the external orifice of the uterus, and onwards to the uterine cavity, fallopian tubes, ovaries, and peritoneal cavity.<ref name=gutierrez2000p356 /> This can cause inflammation of the vulva and vagina.<ref name="cook2009p151632"/><ref name="gutierrez2000p35522"/> This causes vaginal discharge and itchiness of the vulva.<ref name="cook2009p151632"/> The pinworms can also enter the urethra, and presumably, they carry intestinal bacteria with them.<ref name=gutierrez2000p356 /> According to Gutierrez (2000), a statistically significant correlation between pinworm infection and urinary tract infections has been shown;<ref name=gutierrez2000p356 /> however, Burkhart & Burkhart (2005) maintain that the incidence of pinworms as a cause of urinary tract infections remains unknown.<ref name="burkhart2005p83832"/> One report indicated that 36% of young girls with a urinary tract infection also had pinworms.<ref name="burkhart2005p83832"/> Painful urination has been associated with pinworm infection. Sometimes, pinworms can be stopped before reaching the vaginal area <ref name="burkhart2005p83832"/>
The relationship between pinworm infestation and appendicitis (a condition in which the appendix becomes inflamed and filled with pus, causing pain) has been researched, but there is a lack of clear consensus on the matter: While Gutiérrez maintains that there exists a consensus that pinworms do not produce the inflammatory reaction,<ref name="gutierrez2000p3632">Gutiérrez 2005, p. 363.</ref> Cook (1994) states that it is controversial whether pinworms are causatively related to acute appendicitis,<ref name="cook1994p116022"/> and Burkhart & Burkhart (2004) state that pinworm infection causes symptoms of appendicitis to surface.<ref name="burkhart2005p83832"/>
==Cause== thumb|upright=1.3|Pinworm life cycle.
The cause of a pinworm infection is the worm ''Enterobius vermicularis''. The entire lifecycle – from egg to adult – takes place in the human gastrointestinal tract of a single human host.<ref name="cook1994p11592"/><ref name=gutierrez2000p354>Gutiérrez 2005, p. 354.</ref> This process is two to eight weeks.<ref name="burkhart2005p8372">Burkhart & burkhart 2005, p. 837</ref><ref name="cook2009p151632"/>
===Spread=== Pinworm infection spreads through human-to-human transmission, by swallowing infectious pinworm eggs.<ref name="burkhart2005p8372"/><ref name="garcia1999p24622"/> The eggs are hardy and can remain infectious in a moist environment for up to three weeks,<ref name="caldwell1982p3072"/><ref name="burkhart2005p8372"/> though in a warm dry environment they usually last only 1–2 days.<ref>{{Cite journal|last=Cook|first=G.C.|title=Enterobius vermicularis infection|journal=Gut|volume=35|issue=9|pages=1159–1162|issn=0017-5749|pmc=1375686|pmid=7959218|year=1994|doi=10.1136/gut.35.9.1159}}</ref> They do not tolerate heat well, but can survive in low temperatures: at −8 degrees Celsius (18 °F), two-thirds of the eggs are still viable after 18 hours.<ref name="caldwell1982p3072"/>
After the eggs have been initially deposited near the anus, they are readily transmitted to other surfaces through contamination.<ref name="garcia1999p24622"/> The surface of the eggs is sticky when laid,<ref name="cook1994p11592"/><ref name="caldwell1982p3072"/> and the eggs are readily transmitted from their initial deposit near the anus to fingernails, hands, night-clothing and bed linen.<ref name="cook2009p151632"/> From here, eggs are further transmitted to food, water, furniture, toys, bathroom fixtures and other objects.<ref name="cook1994p11592"/><ref name="burkhart2005p8372"/><ref name="garcia1999p24622"/> Household pets often carry the eggs in their fur, while not actually being infected.<ref name="caldwell1982p30832">Caldwell 1982, p. 308.</ref> Dust containing eggs can become airborne and widely dispersed when dislodged from surfaces, for instance when shaking out bed clothes and linen.<ref name="caldwell1982p3072"/><ref name="burkhart2005p8372"/><ref name="caldwell1982p30832"/> Consequently, the eggs can enter the mouth and nose through inhalation, and be swallowed later.<ref name="cook2009p151632"/><ref name="caldwell1982p3072"/><ref name="burkhart2005p8372"/><ref name="garcia1999p24622"/> Although pinworms do not strictly multiply inside the body of their human host,<ref name="cook2009p151632"/> some of the pinworm larvae may hatch on the anal mucosa, and migrate up the bowel and back into the gastrointestinal tract of the original host.<ref name="cook2009p151632"/><ref name="burkhart2005p8372"/> This process is called ''retroinfection''.<ref name="caldwell1982p3072"/><ref name="burkhart2005p8372"/> According to Burkhart (2005), when this retroinfection occurs, it leads to a heavy parasitic load and ensures that the pinworm infestation continues.<ref name="burkhart2005p8372"/> This statement is contradictory to a statement by Caldwell, who contends that retroinfection is rare and not clinically significant.<ref name="caldwell1982p3072"/> Despite the limited, 13-week lifespan of individual pinworms,<ref name="cook1994p11592"/> autoinfection (infection from the original host to itself), either through the anus-to-mouth route or through retroinfection, causes the pinworms to inhabit the same host indefinitely.<ref name="burkhart2005p8372"/>
===Life cycle=== The life cycle begins with eggs being ingested.<ref name="cook1994p11592"/> The eggs hatch in the duodenum (first part of the small intestine).<ref name="garcia1999p24622"/> The emerging pinworm larvae grow rapidly to a size of 140 to 150 micrometres,<ref name="cook2009p151632"/> and migrate through the small intestine towards the colon.<ref name="cook1994p11592"/> During this migration they moult twice and become adults.<ref name="cook1994p11592"/><ref name="burkhart2005p8372"/> Females survive for 5 to 13 weeks, and males about 7 weeks.<ref name="cook1994p11592"/> The male and female pinworms mate in the ileum (last part of the small intestine),<ref name="cook1994p11592"/> whereafter the male pinworms usually die,<ref name="garcia1999p24622">Garcia 1999, p. 246</ref> and are passed out with stool.<ref name="caldwell1982p3072"/> The gravid female pinworms settle in the ileum, caecum (beginning of the large intestine), appendix and ascending colon,<ref name="cook1994p11592"/> where they attach themselves to the mucosa<ref name="burkhart2005p8372"/> and ingest colonic contents.<ref name="gutierrez2000p35522"/> Almost the entire body of a gravid female becomes filled with eggs.<ref name="garcia1999p24622"/> The estimations of the number of eggs in a gravid female pinworm ranges from about 11,000<ref name="cook1994p11592"/> to 16,000.<ref name="burkhart2005p8372"/> The egg-laying process begins approximately five weeks after initial ingestion of pinworm eggs by the human host.<ref name="cook1994p11592"/> The gravid female pinworms migrate through the colon towards the rectum at a rate of 12 to 14 centimetres per hour.<ref name="cook1994p11592"/> They emerge from the anus, and while moving on the skin near the anus, the female pinworms deposit eggs either through contracting and expelling the eggs, dying and then disintegrating, or bodily rupture due to the host scratching the worm.<ref name="garcia1999p24622"/> After depositing the eggs, the female becomes opaque and dies.<ref name="caldwell1982p3072"/> The reason the female emerges from the anus is to obtain the oxygen necessary for the maturation of the eggs.<ref name="caldwell1982p3072"/>
== Diagnosis == [[File:Pinworms in the Appendix (2).jpg|thumb|upright=1.3|High magnification micrograph of a pinworm in cross section in the appendix. H&E stain.]]Diagnosis relies on finding the eggs or the adult pinworms.<ref name="garcia1999p24622"/> Individual eggs are invisible to the naked eye, but they can be seen using a low-power microscope.<ref name="caldwell1982p30832"/> On the other hand, the light-yellowish thread-like adult pinworms are clearly visually detectable, usually during the night when they move near the anus, or on toilet paper.<ref name="burkhart2005p83832"/><ref name="cook1994p116022"/><ref name="caldwell1982p30832"/> Shining a flashlight on the infected individual's anus about one hour after they fall asleep is one form of detection and may show worms crawling out of the anus.<ref>{{Cite web |author=Health Canada|date=1996-05-17 |title=Anthelmintics |url=https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/applications-submissions/guidance-documents/nonprescription-drugs-labelling-standards/anthelmintics.html |access-date=2021-11-23 |website=www.canada.ca}}</ref> Another form of detection is the use of transparent adhesive tape (e.g. Scotch Tape) applied on the anal area which will pick up deposited eggs, and diagnosis can be made by examining the tape with a microscope.<ref name="gutierrez2000p3632"/><ref name="caldwell1982p30832"/> This test is most successful if done every morning for several days, because the females do not lay eggs every day, and the number of eggs varies.<ref name="caldwell1982p30832"/> A third method of diagnosis is examining a sample from under their fingernails under a microscope as itching around the anal area is common and therefore they may have collected some eggs under their nails as a result.<ref>{{Cite web |author=((CDC-Centers for Disease Control and Prevention))|date=2019-04-19 |title=CDC - Enterobiasis - Diagnosis |url=https://www.cdc.gov/parasites/pinworm/diagnosis.html |access-date=2021-11-23 |website=www.cdc.gov |language=en-us}}</ref>
Pinworms do not lay eggs in the feces,<ref name="caldwell1982p30832"/> but sometimes eggs are deposited in the intestine.<ref name="garcia1999p24622"/> As such, routine examination of fecal material gives a positive diagnosis in only 5 to 15% of infected subjects,<ref name="cook1994p116022"/> and is therefore of little practical diagnostic use.<ref name="cook2009p151632"/> In a heavy infection, female pinworms may adhere to stools that pass out through the anus, and they may thus be detected on the surface on the stool.<ref name="cook1994p116022"/><ref name="garcia1999p24622"/> Adult pinworms are occasionally seen during colonoscopy.<ref name="cook1994p116022"/> On a microscopic level, pinworms have an identifying feature of alae (i.e., protruding ridges) running the length of the worm.<ref name="dpdx2">dpdx 2009</ref>
== Prevention == Pinworm infection cannot be totally prevented under most circumstances.<ref name="garcia1999p2472">Garcia 1999, p. 247</ref> This is due to the prevalence of the parasite and the ease of transmission through soiled night clothes, airborne eggs, contaminated furniture, toys and other objects.<ref name="garcia1999p24622"/> Infection may occur in the highest strata of society, where hygiene and nutritional status are typically high.<ref name="cook1994p116123">Cook 1994, p. 1161</ref> The stigma associated with pinworm infection is hence considered a possible over-emphasis.<ref name="cook1994p116123"/> Counselling is sometimes needed for upset parents who have discovered their children are infected, as they may not realize how prevalent the infection is.<ref name="garcia1999p24622" />
Preventive action revolves around personal hygiene and the cleanliness of the living quarters.<ref name="cook1994p116123"/> The ''rate'' of reinfection can be reduced through hygienic measures, and this is recommended especially in recurring cases.<ref name="caldwell1982p30832"/><ref name="cook1994p116123"/>
The main measures are keeping fingernails short, and washing and scrubbing hands and fingers carefully, especially after defecation and before meals.<ref name="cook1994p116123"/><ref name="caldwell1982p30923">Caldwell 1982, p. 309.</ref> Showering every morning is also highly recommended to wash off any eggs that may be still lying on the skin.<ref name=":0">{{Cite web |author=((CDC-Centers for Disease Control and Prevention))|date=2020-12-18 |title=CDC - Enterobiasis - Prevention & Control |url=https://www.cdc.gov/parasites/pinworm/prevent.html |access-date=2021-11-23 |website=www.cdc.gov |language=en-us}}</ref> Under ideal conditions, bed covers, sleeping garments, and hand towels should be changed daily<ref name="cook1994p116123"/> and clothes and linens should be washed in hot water and then be placed in a hot dryer in order to kill off any eggs.<ref name=":0" /> Children can wear gloves while asleep, and the bedroom floor should be kept clean.<ref name="cook1994p116123"/> Regular disinfection of kitchen and bathroom surfaces will help to prevent spread as well.<ref>{{Cite web |date=2018-01-08 |title=Threadworms |url=https://www.nhs.uk/conditions/threadworms/ |access-date=2021-11-23 |website=nhs.uk |language=en}}</ref> Food should be covered to limit contamination with dust-borne parasite eggs.<ref name="cook1994p116123"/> It is not recommended to shake clothes and bed linen as the eggs may detach and spread<ref name="cook1994p116123"/> or to share clothes and towels. Nail biting and sucking on fingers is also discouraged.
==Treatment==
Medication is the primary treatment for pinworm infection.<ref name="cook1994p116123"/> However, reinfection is frequent regardless of the medication used.<ref name="burkhart2005p83832"/> Total elimination of the parasite in a household may require repeated doses of medication for up to a year or more.<ref name="cook2009p151632"/> Because the drugs kill the adult pinworms, but not the eggs, the first retreatment is recommended in two weeks.<ref name="caldwell1982p30832"/> Also, if one household member spreads the eggs to another, it will be a matter of two or three weeks before those eggs become adult worms and thus amenable to treatment.<ref name="caldwell1982p30923"/> Asymptomatic infections, often in small children, can serve as reservoirs of infection, and therefore the entire household should be treated regardless of whether or not symptoms are present.<ref name="cook2009p151632" /><ref name="cook1994p116123" />
The benzimidazole compounds albendazole (brand names e.g., ''Albenza'', ''Eskazole'', ''Zentel'' and ''Andazol'') and mebendazole (brand names e.g., ''Ovex'', ''Vermox'', ''Antiox'' and ''Pripsen'') are the most effective.<ref name="cook1994p116123" /> They work by inhibiting the microtubule function in the pinworm adults, causing glycogen depletion,<ref name="cook1994p116123" /> thereby effectively starving the parasite.<ref name="caldwell1982p30923" /> A single 100 milligram dose of mebendazole with one repetition after two weeks, is considered the safest, and is usually effective with cure rate of 96%.<ref name="burkhart2005p83832" /><ref name="cook1994p116123" /> Mebendazole has no serious side effects, although abdominal pain and diarrhea have been reported.<ref name="cook1994p116123" /> Pyrantel pamoate (also called pyrantel embonate, brand names e.g., ''Reese's Pinworm Medicine'', ''Pin-X'', ''Combantrin'', ''Anthel'', ''Helmintox'', and ''Helmex'') kills adult pinworms through neuromuscular blockade,<ref name="caldwell1982p30923" /> and is considered as effective as the benzimidazole compounds and is used as a second-line medication.<ref name="cook2009p151632" /> In the US, Pyrantel pamoate is available over the counter and does not require a prescription. Pinworms located in the genitourinary system (in this case, female genital area) may require other drug treatments.<ref name="burkhart2005p83832" />
===Treatment in pregnancy and breastfeeding=== The available data on mebendazole, albendazole, and pyrantel pamoate use in pregnancy is limited and they are all assigned to pregnancy category level C. Treatment of a pinworm infection during pregnancy is only recommended for patients with significant symptoms that may be causing adverse effects to the pregnant woman such as loss of sleep and weight loss.<ref name=":12">{{Citation |last1=Rawla |first1=Prashanth |title=Enterobius Vermicularis |date=2021 |url=https://www.ncbi.nlm.nih.gov/books/NBK536974/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30725659 |access-date=2021-11-30 |last2=Sharma |first2=Sandeep}}</ref><ref name=":22">{{Cite web |author=((CDC-Centers for Disease Control and Prevention))|date=2019-08-26 |title=CDC - Enterobiasis - Resources for Health Professionals |url=https://www.cdc.gov/parasites/pinworm/health_professionals/index.html |access-date=2021-11-30 |website=www.cdc.gov |language=en-us}}</ref> Pyrantel pamoate is the treatment of choice in pregnancy but should be used only after consultation with a health care practitioner rather than self-treatment.<ref name=":12" /> Treatment should be avoided in the first trimester, and if possible done in the third trimester.<ref>{{Cite journal |last=Cook |first=G. C. |title=Enterobius vermicularis infection |journal=Gut |year=1994 |volume=35 |issue=9 |pages=1159–1162 |doi=10.1136/gut.35.9.1159 |issn=0017-5749 |pmc=1375686 |pmid=7959218}}</ref><ref name=":22" /> If the pregnant woman is asymptomatic, then they should be treated after the baby is delivered.{{citation needed|date=May 2022}}
Mebendazole has less than 10% of the oral dose absorbed into systemic circulation with a clinically insignificant amount of drug excreted in breastmilk, and therefore treatment should not be withheld during breastfeeding.<ref name=":22" /> There is limited data on the use of pyrantel pamoate and albendazole in breastfeeding but WHO also classifies them as compatible with breastfeeding. This is due to the drugs acting mainly in the intestinal system of the mother with only a very small amount of drug being absorbed into the systemic circulation.<ref name=":22" /><ref>{{Cite web|author=World Health Organization |date=2002 |title=Breastfeeding and maternal medication : recommendations for drugs in the Eleventh WHO Model List of Essential Drugs|publisher=World Health Organization |hdl=10665/62435 |url=https://iris.who.int/handle/10665/62435|language=en|access-date=24 November 2023}}</ref>
==Epidemiology==
Pinworm infection occurs worldwide,<ref name="gutierrez2000p35522"/> and is the most common helminth (i.e., parasitic worm) infection in the United States and Western Europe.<ref name="burkhart2005p8372"/> In the United States, a study by the Center of Disease Control reported an overall incidence rate of 11.4% among people of all ages.<ref name="burkhart2005p8372" /> Pinworms are particularly common in children with approximately 30% of children being infected and most commonly seen in children between 7 and 11 years old.<ref>{{Cite journal |last1=Dezsényi |first1=Balázs |last2=Sárközi |first2=László |last3=Kaiser |first3=László |last4=Tárkányi |first4=Klára |last5=Nikolova |first5=Radka |last6=Belics |first6=Zorán |date=2018-12-01 |title=Gynecological and obstetrical aspects of Enterobius vermicularis infection |journal=Acta Microbiologica et Immunologica Hungarica |volume=65 |issue=4 |pages=459–465 |doi=10.1556/030.65.2018.020 |issn=1217-8950 |pmid=29552897|s2cid=3981456 }}</ref> The prevalence rates in children having been reported as high as 61% in India, 50% in England, 39% in Thailand, 37% in Sweden, and 29% in Denmark.<ref name="burkhart2005p8372" /> Finger sucking has been shown to increase both incidence and relapse rates,<ref name="burkhart2005p8372" /> and nail biting has been similarly associated.<ref name="cook1994p116022"/> Because it spreads from host to host through contamination, enterobiasis is common among people living in close contact, and tends to occur in all people within a household.<ref name="gutierrez2000p35522" /> The prevalence of pinworms is not associated with gender,<ref name="gutierrez2000p35522" /> nor with any particular social class, race, or culture.<ref name="burkhart2005p8372" /> Pinworms are an exception to the tenet that intestinal parasites are uncommon in affluent communities.<ref name="burkhart2005p8372" />
==History== The earliest known instance of pinworms is evidenced by pinworm eggs found in coprolite, carbon dated to 7837 BC at western Utah.<ref name="cook1994p11592"/> Pinworm infection is not classified as a neglected tropical disease unlike many other parasitic worm infections.<ref>{{cite web|title=Fact sheets: neglected tropical diseases|url=https://www.who.int/topics/tropical_diseases/factsheets/neglected/en/|website=World Health Organization|publisher=WHO Media Centre|access-date=6 December 2014|url-status=dead|archive-url=https://web.archive.org/web/20141207163156/http://www.who.int/topics/tropical_diseases/factsheets/neglected/en/|archive-date=7 December 2014}}</ref>
Garlic has been used as a treatment in the ancient cultures of China, India, Egypt, and Greece.<ref>{{cite journal | pmc = 3249897 | pmid=22228949 | doi=10.4103/0973-7847.65321 | volume=4 | issue=7 | title=Extracts from the history and medical properties of garlic | year=2010 | journal=Pharmacognosy Reviews | pages=106–10 |vauthors=Petrovska BB, Cekovska S | doi-access=free }}</ref> Hippocrates mentioned garlic as a remedy against intestinal parasites.<ref>Tucakov J. Beograd: Naucna knjiga; 1948. Farmakognozija; pp. 278–80.</ref> German botanist Adam Lonicer also recommended garlic against parasitic worms.<ref>3. Tucakov J. Beograd: Kultura; 1971. Lecenje biljem - fitoterapija; pp. 180–90.</ref>
==References== {{Reflist}}
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== External links == * {{cite journal |author=Brown MD |title=Images in clinical medicine. Enterobius vermicularis |journal=The New England Journal of Medicine |volume=354 |issue=13 |pages=e12 |date=March 2006 |pmid=16571876 |doi=10.1056/NEJMicm040931}}
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