To treat threadworms successfully, all individuals from the same household as the infected individual should be treated. Since threadworm eggs are easily transmitted via shared clothing, towels, bed linen and various other surfaces, it is important to take measures to clean and disinfect all objects and areas to completely eradicate the risk of spread or recurrence. The primary aim of treatment is complete cure and preventing re-infection.
The treatment outline for threadworm infection includes:
Treating all individuals of the family, even if they do not have the infection
Educating the family members about basic hygiene measures such as hand washing after using the toilet, before meal times and before handling food. Keeping bathroom and kitchen surfaces clean, regularly washing and disinfecting all articles of clothing and bed linen and regularly vacuuming also helps to kill any harbouring eggs.
Children should be discouraged from sucking their thumbs or fingers and all family members are encouraged to keep their nails trimmed and clean. Showering or bathing regularly, especially in the morning, and cleaning the anus and vagina also kills or removes the eggs and prevents transmission.
The eggs are resilient and can survive on surfaces for up to three weeks. All hygiene and disinfection measures should be continued for up to 6 weeks, to ensure complete eradication of the eggs. Basic hygiene such as hand washing and keeping surfaces clean can prevent recurrence.
Medications are used to kill the worms. The two main medications used are mebendazole and piperazine. These are almost 100% effective at killing the adult threadworms but they cannot kill the eggs. Therefore hygiene measures need to be maintained alongside the medication routine.
Good hygiene practices help eradicate the eggs and prevent fresh infection occurring after the medication has killed the adult worms. If the infection persists for over two weeks, a second dose of the medication is advised.
While mebendazole may be given to adults and children aged over two years, piperazine is recommended for children aged between three months and two years. Mebendazole acts by stopping the threadworms from absorbing vital nutrients such as sugars while they are in the gut, which leads to the starvation and death of the worms within a few days.
Piperazine acts by paralyzing the worms which are then passed out of the body in the stool. The use of this agent is usually combined with a laxative to help speed up the passage of the worms.
In pregnant or breastfeeding mothers and in infants below three months of age, medications are not recommended and these group should maintain good hygiene practices to prevent infection.
Reviewed by Sally Robertson, BSc