Pubic lice, also called crab lice, are tiny insects that can cause itching in the area around the genitals. They are spread through close body contact, most often during sexual activity. They can also be spread by sharing clothing, bedding and towels used by a person with lice.
Pediculosis pubis does not lead to serious health problems and is not an STD. It is easy to treat with special shampoos and lotions that kill the lice.
Symptoms
The most common symptom is intense itching in the pubic area or other areas with coarse hair. Pubic lice (Phthirus pubis) are tiny insects that look like crabs and can only survive on human blood, so they have to crawl on people’s hairs to get it. The itching is caused by the lice biting the skin, which causes it to swell up and itch.
Other symptoms include the appearance of small, tan or whitish-gray bumps on the skin where the lice bite. These bumps, called papules or macules, are surrounded by red or blue-gray areas of itching. The itch is sometimes so severe that it can cause secondary bacterial infections. There may be a foul smell coming from the area.
Symptoms can be difficult to notice, especially if you have fine or thin hair. You can usually only see the lice and their eggs (nits) with a magnifying glass. The nits look oval and are yellow, white, or pearly, and they tend to come in clumps. A magnifying glass also makes it easier to spot the blood spots that occur at the bite sites.
You can treat pubic lice with a special lotion, shampoo, or cream that kills them. Many of these are available over-the-counter without a prescription and are safe to use when used according to the directions on the package or in your doctor’s office. Examples of these include permethrin cream rinse, pyrethrins with piperonyl butoxide, and malathion lotion. If these treatments don’t work, your doctor might prescribe a stronger medicine that you take by mouth or apply to the scalp, such as ivermectin.
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Pubic lice can be easily spread through intimate contact, so it’s important to treat everyone who may have them. This includes sexual partners and family members. It’s also a good idea to wash clothes, bedding, and towels in hot water that have come into contact with anyone who has had lice on their body. Don’t skip treatment or ignore symptoms, because untreated pubic lice can become infected with scabies and lead to itching that is worse than the lice itself.
Diagnosis
The tiny insects known as pubic lice — also called crab lice — live on the skin and coarse hairs around the genitals, feeding on blood. The bugs spread easily among people who have close contact, most commonly during sexual activity. The lice don’t carry diseases or cause infections, but they are a nuisance and can be extremely itchy. People often scratch their pubic hair, resulting in sores or a rash. Lice can even be found in the eyebrows or eyelashes (more common in children).
Pubic lice can only be transferred by touching an infested area of the body or hair with an infected hand. Barrier protection, such as wearing a bathing cap or showering in a closed bathroom, does not prevent the transfer of lice. People may also inadvertently pick up the pests when sharing personal items, such as towels or combs. The lice can’t survive without blood, so they die within 24 hours if they don’t get a meal. Female lice produce about 30 eggs, or nits, in their three to four-week life span. Nits are small, oval and white or yellowish and appear to be stuck to the root of hair. They take six to 10 days to hatch into nymphs.
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A doctor or nurse can make a diagnosis of pubic lice by looking for the creatures and their nits on an affected person’s groin, anus, armpit, chest, beard or mustache. Unlike head lice, which have flat heads and can be seen with the naked eye, pubic lice are short and crab-like. Sometimes they can be difficult to spot, requiring a magnifying lens.
If a doctor determines that a person has pubic lice, the health care provider will recommend over-the-counter treatments that kill the lice and their eggs. Treatments include shampoos and creams. A person should use these products as directed. If over-the-counter remedies don’t work, a health care professional can prescribe stronger lotions or shampoos. It is important to follow up with a physician if the over-the-counter treatments don’t work, because any remaining lice can continue to lay eggs and re-infest the person.
Treatment
The main complaint of patients with pediculosis pubis is pruritus (itching) in the pubic area. The diagnosis is confirmed by visual examination of the hair with a light, magnifying lens, or lice comb. Nits, which are small eggs, can be seen in the hair but can be hard to detect, and may look like dandruff, hair spray debris, or dirt particles on the scalp. Misdiagnosis is common because nits are not always present and because dandruff, soap, and other products can be mistaken for lice.
The most effective treatment for pediculosis pubis is a medicated shampoo with 1% permethrin or a lotion with pyrethrins and piperonyl butoxide. The pyrethrins kill the lice by dehydrating them, while butoxide breaks down the protective outer shell of the nits, allowing the nit to be wiped away. The pyrethrin-based products are available over the counter without a prescription at pharmacies and drug stores. They should be used exactly as directed. Neither of these medications should be used near the eyes, as they can cause irritation. In severe cases of pediculosis pubis, a medical professional can prescribe oral ivermectin.
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Pubic lice can also be eradicated by washing clothes, bed linens, and towels in hot water and drying them on a hot cycle. Alternatively, the affected person can use an insecticide such as malathion or lindane. Both lindane and ivermectin are not safe during pregnancy, but there is no evidence of teratogenicity in humans, so they can probably be used safely when the person is breastfeeding as well.
Although some people may feel embarrassment about pubic lice, they are not a marker of sexual abuse or activity. Rather, they can be caused by nongenital bodily contact between close living companions and can even be spread while sitting on toilet seats. They are also linked to poor hygiene, as the lice can live on clothing and fomites such as hats and scarves, making it possible for them to be transferred from one person to another through indirect contact. Pubic lice can also serve as vectors for louse-borne diseases such as epidemic typhus, bartonella quintana endocarditis, and louseborne relapsing fever.
Prevention
Pubic lice (Phthirus pubis) are parasites that live in the hair on the lower part of your body — specifically the pubic region, armpit hair, eyebrows, mustache, beard and eyelashes (in children). They get their name from their crab-like appearance. They are different from head and body lice in that they don’t crawl as fast and are smaller. They can’t jump from person to person, and they don’t live away from a warm body for long.
People usually get pubic lice through close, skin-to-skin sexual contact with someone who has them. They can also be spread by sharing clothes, bedding or towels with a person who has them. It’s not as common, but you can get them by having skin-to-skin contact with a non-sexually infected person, such as when they hug you or kiss you.
Lice don’t carry diseases or cause serious health problems. However, the itching they cause can become an irritation. It can even lead to a bacterial infection in the area if you scratch it a lot.
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There are over-the-counter medications you can use to treat pediculosis pubis. A 1% cream rinse called permethrin can often clear up the problem with one treatment. Another option is a shampoo called pyrethrin with piperonyl butoxide. This works well too, but it may take a few treatments to work.
If over-the-counter methods don’t work, you can ask your doctor for a prescription medication to treat pubic lice. This might be a topical lotion, shampoo or oral medication that you take in two doses.
There are ways to prevent pediculosis pubis, such as regularly checking yourself for lice and nits. You can also help keep yourself free of pubic lice by not having direct, skin-to-skin contact with people who have them or by not sharing clothing, towels or hats with them. Practice safe sex, and make sure all of your sexual partners have been checked for lice and treated, if needed. Wash all clothing and bed linens frequently. Avoid sharing personal items like brushes or combs. And never put a used towel on your head.
