Correspondence (reply): In Reply

We thank our Berlin colleagues for their comments and supplements to our article (1).

In fact, the cited Schwerin study (2) reflects only a narrow geographic area and therefore is not representative of Germany as a whole. Unfortunately, there are almost no other epidemiological studies on the prevalence of pinworm infections in Germany that could be used to draw a more accurate picture. For our assessment of the historical development of infection rates, we also incorporated our personal clinical impressions from sometimes decades-long outpatient practice. Current (nationwide) prevalence studies are urgently needed. The locally clustered detection rates in the Berlin study between 2007 and 2017 (3) should also not have been understood to mean that detection rates increased in individual districts within Berlin, but rather that they increased throughout the Greater Berlin area.

We are also grateful for the supplemental information to the pathogenesis of itching, in which the egg antigens, rather than worm movement, are postulated to be the main cause. While this also seems plausible to us, it currently cannot be substantiated by any study.

It is possible that the worm cuticle is less likely than previously assumed to be destroyed by intense scratching with fingernails (although the epidermis can also be eroded [scratch marks]). Unfortunately, to our knowledge, there are no experimental tests on the elasticity of the Enterobius cuticle.

Pyrvinium embonate is a treatment option for pregnant women after risk–benefit assessment and with careful monitoring. There are no comparative studies on mebendazole use for Enterobius during pregnancy.

It should also be emphasized again that, in the pulse scheme proposed by us for the treatment of chronic recurrent pinworm infection, a single dose of mebendazole once every 14 days is sufficient after completion of the initial therapy.