What should I do if I find a worm in my urine?

Finding a Worm in Urine: Immediate Medical Evaluation Required

If you find a worm in your urine, you should immediately collect the specimen and seek medical attention for proper identification and treatment of the potential parasitic infection. This finding requires prompt evaluation as it may indicate a urinary tract parasitic infection that could impact morbidity and mortality if left untreated.

Initial Steps When Finding a Worm in Urine

1. Preserve the specimen:

   • Collect the urine sample containing the worm in a clean container
   • Do not discard the specimen as it's crucial for identification
   • Keep the container sealed and bring it to your healthcare provider

2. Seek immediate medical attention:

   • Visit your primary care physician, urgent care, or emergency department
   • Bring the specimen with you for laboratory analysis
   • Be prepared to provide travel history, especially to tropical regions

Potential Parasitic Causes

Several parasites can appear in urine, with varying clinical implications:

Common Urinary Parasites:

• Enterobius vermicularis (Pinworm): Though primarily intestinal, can rarely migrate to the urinary tract 1
• Schistosoma haematobium: Can cause bladder outlet obstruction and chronic kidney disease if untreated 2
• Drain fly larvae (Psychoda): Can cause urogenital myiasis with symptoms of urinary frequency and urethral irritation 3

Diagnostic Approach

Your healthcare provider will likely:

1. Examine the specimen to identify the parasite

2. Order additional tests:

   • Microscopic examination of urine for eggs and parasites
   • Urine culture to rule out bacterial infection
   • Blood tests to check for eosinophilia (elevated in many parasitic infections) 4
   • Imaging studies if obstruction is suspected

3. Rule out non-parasitic causes:

   • Blood clots can sometimes appear worm-like in urine 5
   • Tissue debris or mucus strands may mimic worms

Treatment Options

Treatment depends on the specific parasite identified but typically includes:

For intestinal parasites with urinary manifestation:

• Albendazole: 400 mg as a single dose (first-line treatment for many intestinal parasites) 6
• Mebendazole: 100 mg twice daily for 3 days (alternative option) 4
• Ivermectin: 200 μg/kg as a single dose (effective for certain parasites) 6

For schistosomiasis:

• Praziquantel: The drug of choice for Schistosoma haematobium infection 2

For tapeworm infections:

• Praziquantel: 10 mg/kg as a single dose for Taenia saginata 4
• Niclosamide: 2 g as a single dose for Taenia solium 6

Prevention of Reinfection

To prevent reinfection or transmission:

1. Practice good hygiene:

   • Frequent handwashing with soap, especially before eating and after using the toilet
   • Keep fingernails short and clean

2. Environmental measures:

   • Wash bed linens and clothing in hot water
   • Clean bathroom surfaces regularly
   • Ensure proper sewage disposal

3. Follow-up testing:

   • Complete the full course of prescribed medication
   • Return for follow-up testing 2-3 weeks after treatment completion 6

When to Seek Additional Care

Return to your healthcare provider if:

• You continue to see worms in your urine after treatment
• You develop fever, severe pain, or blood in urine
• You experience difficulty urinating or bladder outlet obstruction symptoms

Public Health Considerations

In some cases, parasitic infections may be reportable to public health authorities, especially if they are uncommon in your region 4. Your healthcare provider will determine if notification is necessary.

Remember that prompt identification and treatment of parasitic infections can prevent serious complications including chronic kidney disease and sepsis from urinary tract infections 2.