Inadequate hygiene plays a role in rectal infestation of pinworm (Enterobius vermicularis), a common worldwide nuisance in children. The condition causes an intense vulvovaginitis with discharge in up to 20% of afflicted girls (30). Among the risk factors identified in urban and rural regions worldwide are overcrowded schools, day-care settings or dwellings, improper sanitation, lack of handwashing after toileting and before meals, and inadequate water supplies (31-35). Rectal itching that worsens at night (when the female emerges to lay eggs) is the primary symptom. Scratching spreads the eggs to other parts of the child's environment. To eradicate the infection effectively, the entire family must be treated at the same time, with scrupulous attention to cleaning of bedding, clothes, bathrooms, and surfaces in the home. Similar action should also be undertaken at the site of acquisition.
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