Worm Species and Their Frequencies

Occasionally, a gynecologist is confronted with worms crawling about in the anal region or on the vulva. These are usually pinworms (Enterobius [Oxyuris] vermicularis), also called oxyurids. They are the most common worms in temperate climates and belong to the nematodes, which cause about 90% of all helminthic diseases.

Less common in temperate climates are cestodes, which cause about 9% of helminthic diseases.

Trematodes cause only 1% of helminthic diseases in temperate climates.

Pinworms (Oxyurids)

Pathogen, transmission, and clinical picture. The pinworm Enterobius (Oxyuris) vermicularis is the most common worm species in temperate climates. Pinworms are 3–12 mm long and cause anal itching (Fig. 12.1). They are transmitted by the fecal–oral route. Scratching of the itching area leads to oral uptake of the eggs deposited in the perianal region. The worms live in the ileocecum and may remain for decades as commensal parasites with the affected person. Fertile females migrate down the colon and migrate from the rectum to the outside where they deposit masses of eggs in the perianal region.

Infestation of the genitals is very rare, but it may lead to oxyuriasis of the fallopian tubes. The clinical picture is adnexitis that does not respond to antibiotics. The diagnosis is usually established by chance through histology.

Diagnosis. Pinworm infestation is diagnosed by identification of tiny worms in the stool. When searching intensely under the colposcope, the worms are also found in the perianal or vulvar region (Fig. 12.2). Perianal detection is accomplished by attaching an adhesive tape to the anal region, pulling it off, and mounting it on a slide that is then investigated for eggs under the microscope (Fig. 12.3).

In rare cases, oxyurid eggs may also be observed in cytological smears.

Therapy:

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