Patient education: Pubic lice (Beyond the Basics)
- Adam O Goldstein, MD, MPH
Adam O Goldstein, MD, MPH
- Department of Family Medicine
- University of North Carolina at Chapel Hill
- Beth G Goldstein, MD
Beth G Goldstein, MD
- Adjunct Clinical Assistant Professor
- Department of Dermatology
- University of North Carolina at Chapel Hill
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
There are three types of lice that infest humans (figure 1):
●The head louse
●The body louse
●The pubic louse, or "crab"
Pubic lice (crabs) are most often spread from one person to another through sexual contact. Pubic lice can be found in all parts of the world, affecting men and women of all races.
This article reviews the diagnosis and treatment of pubic lice. Head lice are discussed separately (see "Patient education: Head lice (Beyond the Basics)"). More detailed information about pubic lice is available by subscription. (See "Pediculosis pubis and pediculosis ciliaris".)
PUBIC LICE DESCRIPTION
The pubic or crab louse is tiny and round. It can be difficult to see unless it is filled with blood from a recent feeding. It has crab-like claws that allow it to grasp tightly onto hair. Female lice lay up to 26 eggs (called nits) over a period of three to four weeks. The eggs hatch after about eight days.
Although these lice primarily affect the pubic area, they can also be found on other areas of the body (eyebrows, armpits, beard, mustache). Pubic lice usually are not found on the head. (See "Patient education: Head lice (Beyond the Basics)".)
Animals do not carry or spread pubic lice. However, pubic lice can move and spread from one person to another on clothing, bedsheets, towels, or other shared items.
PUBIC LICE SYMPTOMS
Most people infested with pubic lice have itching in the pubic or genital area. Other parts of the body, such as the armpits, can also be itchy if lice are present. There might be pale bluish spots on the lower belly, upper thighs, or buttocks from repeat feedings in the same area.
Children of parents infested with pubic lice occasionally develop a lice infestation of the eyelashes or eyebrows. This can cause an itching or burning sensation in the eyes, and the eyelids might look red and irritated.
PUBIC LICE DIAGNOSIS
Your doctor or nurse can diagnose pubic lice by looking at the genital area for lice or their eggs (picture 1).
If you are diagnosed with pubic lice, which is a sexually transmitted infection, you should be tested for other sexually transmitted infections, such as gonorrhea, chlamydia, syphilis, and HIV. (See "Patient education: Gonorrhea (Beyond the Basics)" and "Patient education: Chlamydia (Beyond the Basics)" and "Patient education: Testing for HIV (Beyond the Basics)".)
PUBIC LICE TREATMENT
The recommended treatment for pubic lice is a lotion or cream that is applied to the skin. The most commonly used treatments include:
●Permethrin (Nix, Rid)
●Pyrethrin (A-200, Pronto, Tisit)
Before using the treatment, your skin should be cool and dry so that it will not absorb the medicine. You should apply the lotion or cream to the skin and hair in the pubic area and skin around the anus, but not inside the vagina or rectum. Other hairy areas, such as the underarms, chest, back, and thighs should also be treated. After 10 minutes, rinse the treatment off with water.
After treatment, you can remove any lice that you see with your fingernails, a fine-toothed comb, or tweezers. If you continue to feel itchy one week after treatment, see your doctor or nurse again.
If you are diagnosed with pubic lice, you should tell anyone that you have had sex with during the previous month to get treated. You should not have sex again until you are both treated. You should wash any clothing, towels, and bedding used within three days before treatment in hot water and dry the items on the hottest setting. Dry cleaning is another option for cleaning clothing.
If there are items that cannot be washed or dry cleaned, you can place the item in a sealed plastic bag for two weeks.
Eyelash involvement — Eyelash infestation can occur in adolescents or adults who have pubic lice. The eyelashes can also become involved in children who are close contacts of adults with pubic lice. This condition may cause itching, burning, and eye irritation. Children with eyelash infestation may continually rub their eyes.
Children with an infestation of the eyelashes can be treated with petroleum jelly (ask a pharmacist to find petroleum jelly that is safe to use in the eyes as regular petroleum jelly may be irritating). You should apply the petroleum jelly to the eyelids twice a day for 8 to 10 days. The jelly will loosen the lice and nits so that you can pull them off with your fingers. In more severe cases, the child's doctor or nurse might recommend a prescription treatment.
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
●National Library of Medicine
(www.nlm.nih.gov/medlineplus/ency/article/000841.htm, available in Spanish)
●Center for Disease Control and Prevention
●The Nemours Foundation
- Centers for Disease Control and Prevention, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006; 55:1.
- Galiczynski EM Jr, Elston DM. What's eating you? Pubic lice (Pthirus pubis). Cutis 2008; 81:109.
- Leone PA. Scabies and pediculosis pubis: an update of treatment regimens and general review. Clin Infect Dis 2007; 44 Suppl 3:S153.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.