Pubic Lice

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What are pubic lice?

Pubic lice (often called 'crabs') are tiny insects about 1-2 mm long (smaller than a match-head). They are grey or brown in colour. Female lice lay eggs which hatch into lice after about seven days. Pubic lice attach strongly to hairs, and do not wash or brush off with normal cleaning.

Pubic lice commonly affect the pubic hair. However, they may also affect hair around the anus, underarm hair, beard, chest, eyebrows, and body hair. Eyelashes are occasionally affected. Scalp hair is a different type of hair, and is not commonly affected. (A different kind of louse called the head louse is the one that usually infects scalp hair.)

How do you get pubic lice?

You need close contact to pass pubic lice on to others. Sexual contact is the common way. However, close contact with family or friends may be a cause. For example, you may 'catch' pubic lice by hugging or kissing someone with an infected beard or moustache. Pubic lice are not thought to be caught from clothing, bed linen, or toilet seats as they soon die if they are away from a human body.

• The main symptom is itch in the affected areas. This is usually in the pubic hair area. The itch may take several days to begin after you become infected.
• Faint blue spots may appear on the nearby skin.
• Skin irritation and scratching may cause redness or a rash in affected areas.
• You may develop eye inflammation if your eyelashes are affected.
• Some people have no symptoms, but can still pass lice on to others without realising.

What is the treatment for pubic lice?

Treatment is to apply an insecticide to the whole body (but to be careful to avoid getting it in the eyes). Two applications are advised, seven days apart.

The two commonly used insecticides to treat pubic lice are malathion 0.5% aqueous lotion and permethrin 5% dermal cream. They are easy to apply and normally work well if used properly. The following is a general guide giving tips for success.

• Malathion is suitable for all people. Permethrin is not usually used if you are under 18, or if you are pregnant or breast feeding (unless malathion has been tried first and not worked).
• You should apply the lotion or cream to all your body including the scalp. This is because the lice can spread and affect many parts of your body and sometimes even the scalp. You should pay particular attention to hairy parts of your body, especially to pubic hair, hair around your anus, beards, moustaches and eyebrows. Note: this advice is based on national guidelines and may be different to what is said on the insecticide packet. The packet may say only apply from the neck down - but experts recommend that the whole body be treated (taking care to avoid getting the insecticide in the eyes).
• An average adult needs about 100 ml of lotion or 20-30 g of cream to apply to the whole body.
• Apply lotion or cream to cool, dry skin. If you have a hot bath or shower, wait until the skin cools down and is fully dry before applying.
• You should leave the lotion or cream on for the full recommended time, and then wash off. Malathion should be left on for 12 hours (overnight) and then washed off. Permethrin 5% dermal cream should be left on for 24 hours and then washed off.
• If you wash any part of your body during the treatment period, you should re-apply the lotion or cream again to the washed areas.
• You do not need to shave the affected areas. The lotion or cream will clear the lice.
• Some people advise washing bed linen, towels, and clothes (particularly underwear) which has been used since a week before symptoms started. There is no good evidence that this is necessary, but some people prefer to do it.
• If your eyelashes are affected, ask a doctor for advice on how to treat these areas.
• Tell your doctor or pharmacist if you are pregnant or breastfeeding as some treatments may not be suitable.

Re-apply the same treatment after seven days. Although lice are usually killed by one application, not all eggs may be. The second application makes sure that any lice that hatch from eggs that survived the first application will be killed before they are old enough to lay further eggs. Note: this advice is based on national guidelines and may be different to what is said on the insecticide packet. The packet may say that one application is sufficient - but experts recommend the two applications, seven days apart.

Do family and friends need treatment?

Recent close contacts and sexual partners within the past three months should be examined for lice, and treated if infected. Remember, you can have pubic lice without symptoms.

Some other points about pubic lice

• Itching often takes a few days to settle after successful treatment.
• Consult a doctor if symptoms persist after the second application of lotion or cream. This is because pubic lice sometimes become resistant to one type of insecticide and a different insecticide may be needed.
• Avoid close body contact with others until you finish the second treatment application.
• If you got pubic lice from a sexual contact then you should be tested for other sexually transmitted infections (STIs). Your doctor may do this or refer you to a Genito-Urinary Medicine (GUM) clinic.

Further help and information

Your local GUM clinic
If you suspect that you have pubic lice or any other sexually transmitted infection, then see your GP or contact your local Genito-Urinary Medicine (GUM) clinic. You can go to the local GUM clinic without a referral from your GP. You can ring the local hospital and ask for the details of the nearest clinic. It may also be listed in the phone book under 'Genito-Urinary Medicine'.

Sexual Health Information Line
Helpline: 0800 567 123    Textphone: 0800 521 361
Provides information on all aspects of STIs including contact details for GUM clinics.

fpa
Helpline: 0845 310 1334    Web: www.fpa.org.uk
Provides information and advice on all aspects of contraception and sexual health.

British Association for Sexual Health and HIV (BASHH)
www.bashh.org
BASHH is a professional association but their website includes contact details of GUM clinics.

References

• Prodigy Guidance Pubic Lice 2007
• Management of pediculosis pubis Guideline from the British Association for Sexual Health and HIV 2001

© EMIS and PIP 2007   Updated: February 2007   PRODIGY Validated

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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