When should I consider referring a patient with recurrent threadworm infections to a specialist?

Consider referring a patient with recurrent threadworm infections to a specialist if the infections are frequent despite appropriate treatment and strict hygiene measures. This includes cases where reinfection persists despite re-treatment with mebendazole and treatment of all household contacts, or if there is uncertainty about diagnosis or management. In such situations, seek advice from a paediatrician or a consultant in infectious diseases.

Additional considerations for referral include: if the patient is a child under 2 years old, as mebendazole is not licensed for this age group and specialist advice is recommended before treatment; or if the patient is pregnant or breastfeeding and treatment decisions are complex.

Rigorous hygiene measures should be reinforced alongside treatment to prevent reinfection.