Worms in humans
It is an awkward subject, and that is exactly why so much nonsense has grown around it: pumpkin seeds, garlic, "cleanses" and a course of tablets for the…
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Medicines commonly prescribed for Worms in humans
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: TABLET, 100 mgActive substance: mebendazoleManufacturer: Esteve Pharmaceuticals S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 100 mg mebendazole/ 5 mlActive substance: mebendazoleManufacturer: Esteve Pharmaceuticals S.A.Prescription required
It is an awkward subject, and that is exactly why so much nonsense has grown around it: pumpkin seeds, garlic, "cleanses" and a course of tablets for the whole family once a year just in case. The real conversation is straightforward. Worms are parasites that live in the gut or, less often, in other organs. Some are common everywhere, including cities with sound drains; others are brought back from trips. Most are cured in a few days, but they are cured in different ways, and which worm it is decides both the medicine and whether the rest of the household needs testing.
Threadworms: where nearly everything starts
If this is about a child who scratches at night, in the great majority of cases it is threadworms, the commonest worm infection in our part of the world, and it has nothing to do with being unclean: the most careful families get them too.
It happens like this. At night the female comes out and lays her eggs in the folds of skin around the anus, and that is where itching that gets worse towards bedtime comes from, keeping the child awake. They toss and turn, take a long time to fall asleep, and are irritable during the day. Sometimes the worms themselves are visible in the stool or on underwear: white, a few millimetres long, like pieces of thread. The diagnosis is confirmed not by a stool test but by pressing sticky tape to the skin around the anus in the morning, before washing.
The whole household is treated on the same day — everyone living together, whether or not they have symptoms. The point is precisely that it happens at once: treat only the child, and the symptom-free adults will pass them back within a week. The repeat dose, at the proper interval, is decided by a doctor: it is there to catch the worms that hatched from eggs after the first round.
Tablets alone are not enough. On the same day and for the following two weeks: change and wash underwear, pyjamas and bedding without shaking them out, because the eggs scatter around the room; keep nails short; wash hands after the toilet and before eating; wash the child in the morning; put close-fitting underwear on them at night; and wipe surfaces and toys with a damp cloth more often. The itching itself, and what it means when threadworms are not the answer, is covered on the neighbouring page, "Itchy bottom".
How worms get in
The route is nearly always the same: eggs or larvae reach the mouth. The details are these.
- Unwashed hands. The main way. Threadworm eggs end up under the nails of a child who has been scratching, then on door handles, toys and crockery, and from there in the next person's mouth. The eggs are tough and survive for weeks in household dust.
- Badly washed vegetables, herbs and berries from the garden, and on trips also water and street food. This is how roundworms and other soil-dwelling worms are passed on.
- Raw or undercooked meat and fish. Less often, but this is how tapeworms arrive: the pork and beef tapeworms from meat, and other worms from freshwater fish salted at home or barely cooked. A freezer and thorough cooking close this route.
- Bare feet and soil. The larvae of some worms go straight through the skin of the foot. That belongs to warm regions without proper sanitation, not to a European allotment.
One clarification that takes a lot of fear away: worms do not spread from person to person through the air, through a kiss, or through crockery washed in hot water. What spreads is eggs, and nearly always by way of hands.
Travel and the tropics: tests first, not a tablet
If the trouble started after a trip to a warm country, that is a different story, and it is worth working out rather than swallowing "something for worms" blindly.
What people bring home includes roundworm, hookworm, strongyloides and schistosomiasis, which is caught by swimming in fresh water, and also the skin form, in which a winding red line appears on the foot or buttock and creeps a little further day by day — that is a larva travelling through the skin. Some of these infections do not show themselves at once but months and even years later, so the doctor must be told where you were and when, even if the trip was a couple of years ago.
Why treating blindly is a poor idea: different worms need different medicines, no single one covers them all, and a tablet swallowed just in case blurs the picture and makes the real cause harder to find. The tests are not complicated: stool samples looking for eggs, usually several on different days, a blood count that often shows a rise in eosinophils, and if needed a blood test for antibodies and an ultrasound scan. That is one or two weeks, after which the treatment will be the right one.
Cats, dogs and the sandpit
Catching worms from pets is rare, but a couple of situations deserve attention, especially with small children in the house.
- Toxocara, the worm of dogs and cats. Its eggs reach sandpits and soil in animal droppings, and from there a child's mouth. In people the worm never becomes an adult, but the larvae travel through the organs and can cause prolonged fever, a cough, an enlarged liver and, rarely, damage to an eye. Hence a simple rule: cover the sandpit, pick up after the animal at once, and wash hands after playing outside and after handling the pet.
- Echinococcus, a rare but serious infection from dogs, commoner where sheep are kept. A cyst grows slowly in the liver or lung and gives no sign of itself for years. It is dealt with by a surgeon together with an infection specialist, and self-treatment is out of the question.
- Worming cats and dogs regularly to the vet's schedule protects the animal and the people in the house alike.
Threadworms, by contrast, are a purely human parasite: a cat neither brings them nor catches them, and worming the cat when a child has threadworms achieves nothing.
What must not be missed
Most worm infections are not dangerous, but the following signs mean either that worms are not the answer or that this is something more serious than threadworms. They call for a doctor, not a pharmacy:
- unexplained weight loss, weakness, loss of appetite;
- blood in the stool, or black tarry stools;
- diarrhoea lasting more than two weeks, especially if it began after a trip;
- constant or severe abdominal pain, bloating, vomiting;
- anaemia in a child — pallor, listlessness, a low haemoglobin with no clear cause;
- a rash and a cough after a trip, a prolonged fever, night sweats;
- yellowing of the skin and of the whites of the eyes, dark urine;
- a large worm has come out, or a flat white segment the size of a grain of rice;
- a child's itching persists a month after the whole household has been treated properly.
Treatment: the medicine is matched to the parasite
Worm medicines do not act on every worm equally: what kills roundworms does nothing to tapeworms, and treating schistosomiasis or hydatid disease is a separate matter with its own timing and follow-up. Hence the right order: first establish which worm, then treat. With typical threadworms a doctor or pharmacist will name the product straight away; in every other case the tests come first.
Let us say it plainly: "preventive worming courses for the whole family once a year", with no symptoms and no tests, are not medical practice. Nor is it a harmless ritual: these medicines have side effects and contraindications, they are tolerated differently by children, by pregnant women and by people with liver disease, and the habit of an annual "cleanse" means that the real causes of abdominal pain, diarrhoea and weight loss get looked for years too late. What justifies treatment is a parasite that has been found, or a clear clinical picture — not the calendar.
And a word on home remedies. Pumpkin seeds, garlic, wormwood, enemas and devices that "expel parasites" cure none of these infections. Some of those methods are not safe in themselves, and above all, the time spent on them is time in which the worm stays put and the diagnosis is postponed.
What genuinely lowers the risk
- Washing hands with soap after the toilet, after coming in from outside, after soil and animals, and before eating: this works better than any tablet.
- Washing vegetables, fruit and herbs, especially from your own garden and from a market.
- Cooking meat and fish thoroughly; salting or drying fish at home does not remove the risk, freezing it does.
- On trips to places with poor sanitation: bottled or boiled water, no ice in drinks, no raw salads and no fruit peeled by someone else's hands, no walking barefoot on soil and no swimming in fresh water.
- Picking up after the dog and cat at once, worming them to the vet's schedule, and covering the children's sandpit.
- Keeping children's nails short and breaking the habit of biting them: it sounds trivial, but with threadworms it is half the battle.
Online consultation
This is hard to talk about in a consulting room, and a conversation at a distance helps: describing the itching and the stools is easier than turning up in person, and nearly all of it is settled by talking. From the description an Oladoctor doctor will separate typical threadworms from a situation that needs testing, explain how to collect the sample properly, and why an ordinary stool test often shows nothing at all with threadworms. They will set out the plan for the whole household, including the laundry and the timing of the repeat dose, go through any travel, and say which tests make sense after the tropics. And they will warn you honestly when self-treatment is not on: with weight loss, blood in the stool, prolonged diarrhoea or anaemia in a child, an examination comes first.
This material is for information only and does not replace medical advice.
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