It starts with a weird, itchy spot on your foot. You probably think it's just a mosquito bite or maybe you stepped in some poison ivy while walking barefoot to the mailbox. But then it moves. That’s the terrifying hallmark of a hookworm infection, though honestly, most people never even see that part. If you're wondering how can you tell if you have hookworms, you have to look past the "gross-out" factor and pay attention to how your gut and your energy levels are behaving. It’s not just a tropical problem anymore; it's a "did you garden without shoes?" problem.
Hookworms are parasites. Specifically, Ancylostoma duodenale and Necator americanus are the two main culprits that set up shop in humans. They don't just sit there. They bite into the lining of your small intestine and drink.
The "Ground Itch" and the First Clue
The very first sign is often dermatological. When the larvae—which are microscopic, by the way—burrow into your skin, they cause something called "ground itch." It’s an intensely itchy, red, sometimes blistered rash right at the entry point. Most people get this on their feet or ankles because that’s where skin meets soil.
If you’ve been walking barefoot in a damp, shaded area where sanitation might be an issue, and you develop a localized itch that feels deeper than a bug bite, that’s a massive red flag.
Interestingly, there is a specific condition called cutaneous larva migrans. This happens when a type of hookworm that usually prefers dogs or cats gets into a human by mistake. Because we aren't their "normal" hosts, the worms get lost. They wander around just under your skin, creating a visible, winding, red track that looks like a literal map of their journey. It moves a few millimeters every day. It’s haunting to look at, but it’s a definitive way to know something is wrong.
The Weird Cough You Can't Explain
Here is the part that trips everyone up. You wouldn’t think a digestive parasite would cause a cough, right? But hookworms have a wild life cycle. Once they get through your skin, they hitch a ride in your bloodstream to your lungs.
They break into your air sacs.
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You might feel a slight wheeze or a dry, hacking cough. Some people even experience a low-grade fever during this phase. This is your body reacting to the physical presence of larvae moving up your windpipe. You eventually swallow them—usually without realizing it—and that is how they finally reach their destination: the small intestine. If you had a strange skin rash a week ago and now you have a persistent, unexplained tickle in your throat, you need to start connecting those dots.
Your Gut is the Main Stage
Once they’ve matured and latched onto your intestinal wall, the symptoms shift. This is where the long-term damage happens. How can you tell if you have hookworms once they've settled in? Your stomach will let you know, but the signs are often frustratingly vague.
- Abdominal Pain: It’s usually a dull ache or a "heavy" feeling in the upper belly.
- Nausea: It comes and goes, often worse right after you eat.
- Loss of Appetite: You might find yourself picking at food you used to love.
- Diarrhea: It can be intermittent and sometimes accompanied by an unpleasant amount of bloating.
Dr. Peter Hotez, a renowned expert in neglected tropical diseases, often points out that hookworm infections are "poverty promoters." They don't always kill you, but they drain your vitality. In a healthy adult with a good diet, a few worms might cause zero symptoms. You could have them for years and never know. But if the "worm burden"—the actual number of parasites—is high, your body starts losing the war for resources.
The Iron Thief: Why You're So Tired
The most dangerous thing about hookworms isn't the "creepy crawly" factor. It’s the blood loss. Each worm is a tiny vampire. They secrete an anticoagulant so your blood doesn't clot while they feed.
When you have hundreds of these things, you develop iron-deficiency anemia.
Are you suddenly exhausted? Do you get winded walking up a single flight of stairs? Look at your fingernails and the inside of your lower eyelids. If they look pale instead of a healthy pink, your red blood cell count might be tanking. In kids, this is devastating. It leads to "stunting"—physical and cognitive delays because the brain and body simply aren't getting the oxygen and iron they need to grow.
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In some parts of the American South, specifically rural Alabama, researchers like Catherine Flowers have highlighted that failing septic systems have allowed hookworms to persist in the soil, leading to widespread, undiagnosed fatigue and anemia in local communities. This isn't just a "somewhere else" problem.
How Doctors Actually Find Them
You can't just look in the toilet and see them. Unlike roundworms, which can be quite large, adult hookworms are tiny—only about half an inch long—and they stay firmly attached to your insides. They don't usually pass out of the body alive.
To get a real answer, a doctor has to do a "fecal egg count." They look at a stool sample under a microscope to find the eggs the female worms are pumping out by the thousands.
Even then, it's tricky. If the worms are still migrating through your lungs or haven't matured yet, the stool test will come back negative. Timing is everything. Sometimes, a doctor will see an elevated level of eosinophils (a type of white blood cell) in a standard blood test, which tells them your body is fighting something parasitic, even if they haven't found the eggs yet.
Don't Fall for "Natural" Cleanses
You’ll see a lot of "parasite cleanses" on social media involving papaya seeds or oregano oil. While some plants have anthelmintic properties, they are rarely enough to clear a systemic hookworm infection.
The gold standard is medication like Albendazole or Mebendazole. These aren't scary drugs; they basically just starve the worms of glucose so they can't survive. Usually, a single dose or a three-day course is all it takes to wipe them out. If you're anemic, you'll also need iron supplements to rebuild your stores, which can take months.
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Immediate Steps to Take
If you suspect you're playing host to these hitchhikers, don't panic. It's treatable. But you need to be methodical.
1. Trace your steps. Did you walk barefoot in an area with poor drainage or potential sewage contamination in the last 4 to 8 weeks? This is the most common exposure route.
2. Check your skin. Look for that winding, raised red line or a cluster of intensely itchy bumps on your feet. Document these with photos for your doctor.
3. Monitor your energy. If you are experiencing "brain fog" alongside digestive upset and you’ve noticed you’re paler than usual, it’s time for a blood panel to check your iron and hemoglobin levels.
4. Get the right test. Ask your healthcare provider specifically for an "Ova and Parasite" (O&P) stool exam. Mention your travel history or any barefoot gardening habits. One test might not be enough; sometimes three samples taken on different days are needed to catch the eggs.
5. Fix the environment. If you have pets, make sure they are on a deworming schedule. If your backyard stays soggy, wear shoes. Hookworm larvae can't bite through leather or thick rubber soles. They are opportunists waiting for a bare heel.
The reality is that hookworms are masters of stealth. They thrive on the fact that we don't think about them. By the time you feel truly sick, they've likely been there for a while. Pay attention to the "ground itch" and the fatigue—they are the loudest whispers your body will give you.