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What is it?
Pubic lice (Phthirus pubis) are tiny parasitic insects found on coarse human body hair, such as pubic hair. They are sometimes referred to as “crabs”
They can sometimes be found on:
They are not head lice so don’t live in scalp hair.
How will I know I have got it?
Pubic lice are spread through close bodily contact, most commonly sexual contact.
Pubic lice or ‘crabs’, are caught from vaginal, anal or oral sex and close genital contact.
The lice cannot jump or fly; they crawl from hair to hair and need human blood to survive. They will only leave the body to move from one person to another. Using condoms and other methods of barrier contraception doesn’t protect you against pubic lice.
Other types of close bodily contact, such as hugging and kissing, can also spread the lice.
It’s also possible – though rarer – to be passed through towels, bedding or other close contact.
Symptoms:
It can take several weeks before any symptoms appear. Symptoms are the same for men and women and include:
Itching is the most common symptom; it is an allergic reaction to their saliva. The itching tends to be worse at night when the lice are most active.
What do pubic lice look like?
Adult pubic lice are very small (2mm long) so are not easy to see. They have a yellowy-grey or dusky-red colour and six legs.
Pubic lice have two large front legs that look like the claws of a crab; they are used to hold onto the base of hairs.
Lice lay eggs (nits) in sacs that stick firmly to hairs, they are a pale brownish colour. When the eggs hatch, the empty egg sacs are white.
Although small and difficult to see, lice and nits may be visible on coarse hair anywhere on the body (apart from head hair).
If you think you have pubic lice you can consult a GP or Practice nurse, or go to a sexual health clinic, also known as a genitourinary medicine (GUM) clinic.
Pubic lice are usually easy to diagnose by examining the affected area. The doctor or nurse may use a magnifying glass to look for signs of the lice, such as pale-coloured eggs or the lice themselves.
Pubic lice are treated with insecticide cream, lotion or shampoo. Your doctor or pharmacist will advise you about which treatment is best to use and will explain how to how to use it. It is important to follow this advice.
There are different treatments:
It is important to take care to avoid the eyes. Treatment will usually need to be repeated after a few days (three to seven).
Pubic lice can develop resistance to some treatments so if the treatment is unsuccessful, you may need to use another type. Your doctor or pharmacist will be able to advise you about suitable alternatives.
It is important to prevent re-infestation, so treatment should be offered to anyone you’ve had close bodily contact with, including any sexual partners you’ve had in the past three months – even if they symptom-free. If you prefer, staff at the clinic can contact a person on your behalf without releasing your details.
Certain groups may require a specific type of treatment, such as young people aged under 18 years, pregnant or breastfeeding women. Ask your doctor or pharmacist if you need advice about this.
Applying the treatment
Most lotions, creams or shampoos have the following instructions:
If you think it hasn’t worked consult your GP or pharmacist for advice. You should not use the medication more than twice.
Side effects
The insecticides used to treat pubic lice may cause skin irritation, such as itchiness, burning, stinging or redness. If this happens, wash the insecticide off the affected area.
Some products may discolour bleached, permed, or coloured hair. Read at the patient information leaflet before applying.
Follow-up treatment
The first treatment application should kill the lice however the eggs may not have been destroyed. This means more lice could hatch and the cycle will start again.
Reapplication of the treatment after three or seven days should ensure that any remaining lice are killed before they are mature enough to lay eggs.
A week after your second treatment you can check for lice or return to your GP, practice nurse, or sexual health clinic so they can check for you.
Empty eggshells (dead nits) can remain stuck to the hairs even after treatment so finding them does not mean that you are still infested.
Treating an eyelash infestation
Eyelash infestations are rare; if infested you should get specialist advice from your doctor. They’ll be able to recommend the correct treatment for you.
You cannot use the same insecticide lotion or cream that’s used for the body as it can irritate eyes. It is important to follow the treatment instructions carefully.
Washing clothing, towels and bedding
To kill lice and to prevent further infection wash clothing, towels and bedding in a washing machine. This should be on a hot cycle (50C or higher)
Complications
Sometimes, minor complications can result from pubic lice infestation, such as skin or eye problems.
Scratching may irritate the skin, or lead to an infection such as impetigo (a bacterial skin infection) or furunculosis (boils on the skin).
Eye infections, such as conjunctivitis, and eye inflammation, such as blepharitis, can sometimes develop if your eyelashes have been infested.
You must medical advice if you have severe skin irritation or sore eyes.
Using condoms during sexual intercourse can prevent STIs. If you have a new partner, it is a good idea for you both to be tested for sexually transmitted infections before having sex.
