Gut Worms Turning Your Colony Into a Puke Zone? Here's the Fix
Contents
Pro Tips
⭐ Don't reset progress: Missing a treatment doesn't reset your cure progress!
⭐ Small meals: Feed sick pawns multiple small meals like pemmican instead of full meals.
⭐ Plan for next time: Consider bionic stomachs for key colonists as prevention.
Quick-Start: 5 Steps to Cure Gut Worms Fast
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Prioritize a Clean Sickbed:
Move the afflicted pawn to a clean room (ideally a hospital bed). Clean surroundings reduce other complications.
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Best Doctor & Medicine:
Have your highest-skill doctor tend the patient. Use the best available medicine for high tend quality (reaching 300% total quality faster). For comprehensive medical care strategies, see our complete medical guide.
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Repeat Tending on Schedule:
Tend every 48 hours. Set patient to "Bed Rest" (priority 1) so they don't miss treatments.
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Manage Hunger and Vomiting:
Colonists eat twice as much with gut worms. Use small meals or pemmican to maximize nutrition absorption between vomiting episodes.
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Consider Instant Cures:
If available, use a Healer Mech Serum, install a Bionic Stomach, or use a Biosculpter Pod medical cycle for an instant cure. Learn more about optimizing biosculpter pods in our biosculpter speed guide.
Why Gut Worms Are a Big Deal
Double Hunger, Half the Progress
Colonists eat twice as much food and vomit frequently, interrupting meals. This can rapidly deplete food stores and cause malnutrition spirals.
Constant Sick & Pain Debuffs
+20% pain and -5 mood from feeling sick. These stack with other issues and slow down work speed while increasing mental break risks.
Mess and Food Poisoning Risks
Vomit lowers cleanliness, leading to food poisoning outbreaks - especially if your cook is infected. A truly vicious cycle.
Long Recovery Time
Gut worms don't go away on their own - they require multiple treatments over 6-10 days, consuming valuable medicine and doctor time.
Hits at the Worst Time
Gut worms often strike before raids or crises. Imagine half your colony doubled over puking during a mechanoid attack! Learn defensive strategies in our combat defense guide.
Gut Worms 101: Understanding the Enemy
What Are Gut Worms?
Gut worms is a non-lethal parasitic disease that can randomly affect any colonist. Despite in-game lore implying it comes from raw food, it's actually a random event triggered by your storyteller. It can't be prevented through hygiene or diet in vanilla gameplay. New to RimWorld? Check our beginner's guide to learn the basics first.
The 300% Cure Threshold
Unlike other diseases that develop immunity, gut worms require cumulative treatment quality totaling 300% to be cured. This means:
- 3 treatments at 100% quality each (ideal scenario)
- About 5 treatments at 60-70% quality (typical scenario)
- 6-8 treatments at 40-50% quality (worst-case scenario)
Treatment Progress Tracking
Key Mechanics to Remember
- Treatments are available every 48 hours.
- Missing a treatment window doesn't reset progress (contrary to myths).
- No "immunity" develops - pawns can't fight it off on their own.
- Gut worms won't directly kill a pawn, but the side effects can be deadly.
Early-Game Tactics: Surviving a Gut Worm Outbreak
EMERGENCY RESPONSE
When gut worms hit early game with limited resources, focus on these priorities:
Triage Who's Afflicted
If multiple colonists are infected, prioritize treatment for key pawns:
- Doctors (they need to recover to treat others)
- Cooks (infected cooks increase food poisoning risk)
- Essential specialists (your only researcher, crafter, etc.)
Use your best medicine on these priority colonists - others can wait or use lower quality care if supplies are limited. For advanced medicine like Glitterworld meds, see our Glitterworld medicine guide.
Herbal Medicine Management
Early game usually means relying on herbal medicine (max 70% tend quality):
- Set aside 5-8 herbal meds per infected colonist
- Consider using 1-2 industrial meds for key tends to reach 300% faster
- If no meds available, even no-medicine tends (40% max) still count toward cure
Improvise a Hospital
A proper hospital greatly improves tend quality (for optimal hospital design, see our colony layout guide):
- Designate a clean room (even a wooden floor is better than dirt)
- Use your best beds (medical beds if available)
- Assign infected pawns to bed rest (priority 1)
- Restrict them to a safe zone to prevent them wandering off
The hospital layout shown above demonstrates an efficient setup that maximizes treatment quality while minimizing doctor travel time.
Food Crisis Management
Double consumption rates require immediate action:
- Hunt additional animals or harvest wild plants immediately
- Use nutrient paste dispensers if available (efficiency bonus)
- Consider relaxing food restrictions temporarily (allow insect meat, etc.)
- Feed small, frequent meals (colonists might keep down small portions before vomiting)
Mood Management
Prevent mental breaks with these mood-boosting strategies:
- Schedule extra recreation time for sick pawns
- Consider controlled substance use if necessary (beer or smokeleaf to offset mood penalties)
- Keep the environment clean (vomit reduces room beauty and cleanliness)
- Improve the patient's surroundings (add a plant, artwork, etc. to their room)
High-Tech and Advanced Solutions
Royalty DLC
Healer Mech Serum
One-use artifact that instantly cures gut worms. Save for emergencies or when multiple key pawns are affected simultaneously. Learn more about acquiring rare medical items in our Glitterworld medicine guide.
Bionic Stomach
Installing this replacement stomach both cures and permanently prevents gut worms. Consider prioritizing for your cook or doctor.
Ideology DLC
Biosculpter Pod
Medical cycle purges gut worms in 3 days. Fully automated and requires no medicine, but colonist must remain in pod. Learn how to optimize biosculpter pods in our biosculpter speed guide.
Preach Health
Moral Guide role can boost healing rate by 25% for 3 days. Speeds recovery from associated health issues.
Biotech DLC
Perfect Immunity Gene
Archite gene that makes pawns completely immune to diseases, including gut worms. Expensive but permanent solution.
Sanguophage Transformation
Sanguophages (vampire-like beings) are immune to all diseases. Extreme solution with other gameplay implications.
Anomaly DLC
Fleshmass Stomach
This fleshy artificial stomach prevents and cures gut worms, similar to bionic stomachs. Obtained through Anomaly events.
Other Advanced Tactics
Hospital Optimization
For maximum tend quality (detailed hospital setup in our medical guide):
- Build rooms with sterile tiles (+4 cleanliness)
- Install vitals monitors connected to medical beds (+8% medical tend quality)
- Keep medicine in a shelf right in the hospital (reduces travel time)
- Use hospital beds (+8% medical tend quality)
The setup shown demonstrates proper medical bed placement with vitals monitors and organized medicine storage for optimal gut worm treatment.
Cryptosleep Solutions
In emergency situations:
- Place infected colonists in cryptosleep caskets to pause their needs
- Useful during food shortages, caravans, or when medical care is unavailable
- Disease progression freezes until they're removed from cryptosleep
- Remember to treat them immediately after waking!
Dealing with Gut Worms Using Mods
Preventative Medicine Mods
VGP Garden Medicine
Adds craftable medicines that prevent specific diseases:
- De-Worm: Prevents gut worms and muscle parasites for 5 days
- Mecha-Gone: Prevents mechanite diseases for 15 days
Disease Overhaul Mods
Diseases+
Expands disease mechanics and adds new treatment options, including specialized research for parasite cures.
Diseases Overhauled
Makes diseases more realistic and challenging, but adds new medicines and treatments to compensate.
Expanded Prosthetics and Organ Engineering
EPOE & Rah's Bionics
Popular mods that add:
- Craftable bionic organs (including stomachs)
- Specialized surgeries to directly remove parasites
- Advanced medicine crafting options
- Research projects for disease cures and prevention
Last Resort Options
Developer Mode
Enable Dev Mode in options, then use debug actions to remove hediffs (diseases) from pawns. A "cheat" option when RNG feels particularly cruel.
Scenario Editor
In custom scenarios, disable or reduce frequency of "Disease: Gut Worms" incident. Must be done at game start, cannot be changed mid-game.
Putting It All Together: Recovery & Prevention
Dealing with gut worms effectively requires a multi-pronged approach:
Treatment
- Clean bed in hospital setting
- Best doctor and medicine
- Tend every 48 hours without fail
- Reach 300% total tend quality
Symptom Management
- Extra food stocks for doubled hunger
- Small, frequent meals to combat vomiting
- Keep colony clean to prevent food poisoning
- Mood management to prevent breaks
Long-Term Prevention
- Bionic stomachs for key colonists
- Hospital facilities for better tend quality
- Consider DLC options (genes, biosculpters, etc.)
- Preventative mods if playing modded
REMEMBER
In a brutal RimWorld naked-brutality start, gut worms can feel like a death sentence. In a well-prepared late-game base, you might just chuckle as your janitor bot cleans up the vomit and your medic pops in for a 110% tend with Glitterworld meds – and it's gone in 3 days. Progress is turning gut worms from a nightmare into an anecdote. For more survival strategies, check our complete beginner's guide.
Frequently Asked Questions
Can colonists die from gut worms?
Gut worms won't directly kill colonists, but the side effects can be lethal. Starvation from doubled hunger, mental breaks from pain, or being incapacitated during dangerous events can all lead to death.
How long do gut worms last without treatment?
Without treatment, gut worms will persist indefinitely. They do not go away on their own and do not develop immunity. With proper treatment (reaching 300% total tend quality), they typically last 6-10 days.
Does Penoxycyline prevent gut worms?
No, Penoxycyline does not prevent gut worms. It only prevents malaria, sleeping sickness, plague, and flu. In vanilla RimWorld, there is no preventative medicine for gut worms, though certain mods add this functionality.
Are gut worms contagious between colonists?
In vanilla RimWorld, gut worms are not contagious. Multiple colonists may get infected simultaneously as part of the same random event, but infected colonists cannot spread gut worms to others. Some disease overhaul mods may change this behavior.