Pubic lice, often referred to as "crabs," are small parasitic insects that attach themselves to human hairs and cause the skin to become itchy and irritated. These lice are prevalent worldwide and are most commonly found in pubic hair, but they can also be found in underarm and facial hair, and even eyelashes. These lice are different from head lice. Pubic lice will only infest parts of the body with thick, coarse hair. The infestation can affect people in all regions of the world, regardless of ethnicity, culture, and social status.1
Pubic lice can be transmitted in several ways. Transmission can occur through direct physical contact with an infected person, most commonly through genital contact. Transmission can also occur through contact with an infected person's bed linens, towels, or clothes, as the lice can survive for up to two days without a human host. They cannot jump from person to person or be transmitted through animals.2
Once pubic lice are contracted and an insect is secured onto the body, adult lice lay their eggs, or "nits," on hair shafts near the skin. The eggs are typically oval shaped and white or yellow in color and hatch in approximately seven to ten days. The lice then feed on human blood.2
Common symptoms of pubic lice can include itching that worsens at night, a rash, or faint bluish spots visible at the site of bites. Adult lice range from 1.1 to 1.8 mm in length and can sometimes be seen at the base of coarse hair along with their eggs near the skin. Pubic lice do not transmit other diseases. They may however, cause a secondary bacterial infection due to excessive scratching and itching of the skin and open sores that can be exposed to other bacteria.1 Excessive scratching may cause the skin to bleed. If lice infect the eyebrows or eyelashes, these areas may become inflamed. Symptoms can be noticeable immediately after transmission, or they may be delayed 2 to 4 weeks if the eggs have not yet hatched.2
Many people have pubic lice, but are asymptomatic; meaning they have no symptoms. This is generally due to how difficult it can be to see the lice, especially when located in the pubic region. White lice blend in with white skin, and brown lice can be mistaken for moles or be hard to identify on darker skin tones.1
Pubic lice and nits are not killed or removed from hair with ordinary soap and water, so a special treatment is necessary. It is recommended to use a lotion containining 1% permethrin. A single treatment is usually powerful enough to stop an infestation. The medicine is available over the counter (without a prescription) at most local drugstores and pharmacies, but it may also be found online.1 If lice are present in eyebrows, eyelashes or facial hair, remove the nits and lice with a comb or tweezers. See a healthcare provider for additional treatment, but do not use permethrin or similar products near your eyes, mouth, or on the face. Directions for using the lice killing lotion must be thoroughly read and followed before using, in order to achieve best results. Before treating, pubic lice should be diagnosed by a healthcare professional, and treatment should be used under their supervision.2
After using the medication, the lice and eggs will usually have to be combed or tweezed out of the infected region. Be sure to machine wash all clothing, towels, and bed linens that the infected person was exposed to 2 to 3 days before treatment with hot water. They should also be dried at high temperature, at at least 130℉ (54℃).1 Place all items that cannot be laundered in a plastic bag for a minimum of thirty days in order to kill any remaining lice. Sanitize the bathroom and shower using a cleaning solution such as bleach.2
If lice are still found seven to ten days after treatment, the permethrin treatment may be repeated. If an infected person has found themselves allergic or intolerant to the first line treatment of permethrin, lindane shampoo is a second line treatment that may be prescribed by a doctor. This medication can be toxic to the brain and can pose other threats to the nervous system. It should not be used to treat patients with high risk conditions such as cancer, or patients who are infants, children, elderly, pregnant or breastfeeding. Immunodeficient patients should not use this treatment either.1
Be aware that itching for an additional one to two weeks after treatment is common, due to allergic reactions from the bites. Seek immediate medical attention if you experience redness, swelling, tenderness, or discharge around the areas of infestation.2
In order to prevent further infestations of pubic lice it is important that an infested person contact past partners or people they have shared linens, towels, or clothing with to inform them of their current condition. This will allow their partners to check if they have become infested with pubic lice and seek medical attention and treatment before it is transmitted.
Condoms, though they protect against most sexually transmitted infections, do not protect against pubic lice. Because they spread through direct physical contact, it is difficult to prevent pubic lice transmission if one is sexually active. It is best to communicate with your partner about STIs and sexual health, and to conduct self exams. If you notice any drastic changes in your genitals, you may want to contact a medical professional.
Maintaining pubic hair can also help prevent the spread of pubic lice. The lice and eggs live on coarse hair and therefore hair removal, shaving or waxing, can reduce the transmission or infestation of pubic lice. Regularly washing clothes and linens at high temperatures is another way to control the spread of pubic lice.1
Pubic lice are a fairly common sexually transmitted infection that affects a wide range of people. In the United States pubic lice affects 3 million people each year, approximately 1 in 90 people. Although it is an uncomfortable and irritable infection, treatment is fairly simple with over-the-counter medications. It is crucial to inform those whom have had intimate contact with the infected person of their condition so that they too can seek treatment, and avoid additional contact until the infestation is fully eradicated.
- "Treatment." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, Web. 15 Nov. 2016. Last Updated: 17 Aug. 2015.
- "Pubic Lice" McKinley Health Center Web Site sponsored by the University of Illinois Last Updated: 22 Aug 2002
- "Statistics about Pubic Lice." Statistics about Pubic Lice - RightDiagnosis.com. N.p., n.d. Web. 29 Nov. 2016.
Last Updated 29 November 2016