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Pubic lice

Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 6 minutes read
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Pubic lice, commonly known as crabs or crab lice, are small parasitic insects that infest the pubic hair region and sometimes other areas of the body with coarse hair. While not typically considered a serious medical condition, pubic lice infestations can cause discomfort, itching, and embarrassment. Understanding the symptoms, transmission methods, and treatment options for pubic lice is essential for effective management and prevention of infestations.

What are the symptoms of pubic lice?

The primary symptom of pubic lice infestation is itching in the pubic hair region, which may range from mild to severe and can be worse at night. This itching is caused by an allergic reaction to the lice bites and their saliva. Other symptoms of pubic lice infestation may include:

  1. Visible lice. Adult pubic lice are tiny insects, roughly the size of a pinhead, with crab-like claws adapted for grasping onto hair shafts. They are pale grey or tan in colour and may appear darker after feeding on blood. Pubic lice eggs, known as nits, are oval-shaped and often attached firmly to the base of hair shafts.

  2. Irritation. Infestation may cause redness, inflammation, and irritation in the affected area, particularly in response to scratching.

  3. Nits. Nits, or lice eggs, may be visible attached to the base of hair shafts. They appear as small, oval-shaped structures and may be mistaken for dandruff or debris.

  4. Secondary infections. Intense scratching of the affected area can lead to breaks in the skin, increasing the risk of secondary bacterial skin infections.

  5. Insomnia. Severe itching and discomfort may interfere with sleep, leading to insomnia or disrupted sleep patterns.

It is important to note that not everyone with pubic lice infestation experiences symptoms, particularly in mild cases. Some individuals may be asymptomatic carriers and may not realise they are infested until the lice or nits are discovered during routine grooming or examination.

How is pubic lice spread?

Pubic lice are primarily spread through close personal contact, including sexual contact, but they can also be transmitted through sharing contaminated bedding, towels, or clothing. Individuals who come into contact with infested persons or contaminated items are at risk of acquiring pubic lice. Common modes of transmission include:

  • Pubic lice are commonly spread through sexual contact, including vaginal, anal, or oral sex. Infestation can occur even with brief skin-to-skin contact.
  • Sharing bedding, towels, or clothing with an infested individual can also result in pubic lice transmission. Lice can survive for a short period off the human body, allowing them to spread through shared items. Pubic lice are different to bedbugs.
  • Sharing personal items such as combs, brushes, or clothing, particularly items worn close to the body, can facilitate pubic lice transmission.
  • While less common, pubic lice infestations can potentially occur through contact with infested surfaces in public spaces, such as shared bedding in hostels or communal showers in gyms.

Risk factors for pubic lice

Several factors may increase the risk of pubic lice infestation, including:

Sexual activity - Individuals who are sexually active, particularly those with multiple partners, are at increased risk of acquiring pubic lice through sexual contact.

Close contact - Close personal contact with an infested individual or sharing personal items with them increases the risk of pubic lice transmission.

Poor hygiene - Poor personal hygiene practices, such as infrequent bathing or sharing contaminated items, can increase the likelihood of pubic lice infestation.

Crowded living conditions - Living in crowded or communal settings, such as dormitories or group homes, may increase the risk of pubic lice transmission due to close proximity to infested individuals and shared living spaces.

Diagnosing pubic lice

Diagnosing pubic lice infestation typically involves a visual examination of the affected area. Your GP may use a magnifying glass or a specialised tool to identify adult lice or nits attached to the hair shafts. In some cases, a sample of skin or hair may be collected and examined under a microscope to confirm the presence of pubic lice or nits.

Treatment Options for Pubic Lice

Treatment for pubic lice infestation aims to eliminate the lice and their eggs and relieve symptoms of itching and irritation. Several treatment options are available, including:

Medicated lotions & shampoos

Over-the-counter or prescription medicated lotions or shampoos containing permethrin or other ingredients are commonly used to treat pubic lice infestations. The most commonly used over-the-counter formulation is Lyclear cream. These products work by killing the lice and their eggs. It is essential to follow the instructions carefully and thoroughly apply the treatment to all affected areas.

Physical removal

In addition to using medicated treatments, manually removing adult lice and nits from the hair shafts using a fine-toothed "nitfree" comb or tweezers may help eliminate infestations. This method may be time-consuming but can be effective, particularly for individuals who prefer non-chemical approaches or for treating young children.

Washing all clothing and linen

Washing bedding, clothing, towels, and personal items in hot water and drying them on high heat can help eliminate pubic lice and prevent re-infestation. Items that cannot be washed should be sealed in a plastic bag for at least two weeks to kill any remaining lice or nits.

Follow-up treatment

Repeat treatment may be necessary to ensure complete eradication of pubic lice and their eggs. It is essential to closely follow the recommended treatment regimen and schedule.

Prevention of pubic lice infestation

Preventing pubic lice infestation involves practising good personal hygiene and taking precautions to avoid close contact with infested individuals or contaminated items. Here are some preventive measures:

Practising safe sex - Using condoms during sexual activity can help reduce the risk of pubic lice transmission. This does not completely reduce the risk of transmission.

Avoiding sharing personal items - Refrain from sharing personal items such as towels, bedding, clothing, combs, or brushes with others, particularly those who may be infested.

Regular screening - Individuals who are sexually active or at increased risk of pubic lice infestation should consider regular screening for sexually transmitted infections (STIs), including pubic lice.

Maintaining personal hygiene - Practicing good personal hygiene, including regular bathing and washing of clothing and bedding, can help reduce the risk of pubic lice infestation.

Educating others - Educating individuals about the risks of pubic lice infestation and how to prevent transmission can help raise awareness and promote healthy behaviours.

When should I see my doctor?

You should see your doctor or sexual health centre so that you can be treated. Clean the bed sheets, as the lice can spread to your partner or anybody who sleeps in the same bed. It is important that you avoid any sexual contact until treated, as lice can be spread through skin contact.

Common asked questions answered

Are pubic lice the same as head lice?

While both pubic lice and head lice are parasitic insects that infest human hair, they are different species with distinct preferences for their habitats. Pubic lice, as the name suggests, primarily infest the pubic hair region, but they can also affect other areas with coarse body hair, such as the armpits, chest, and beard. In contrast, head lice infest the scalp and hair on the head, particularly among children.

Will pubic lice ever go away?

Pubic lice infestations can persist indefinitely if left untreated. However, with prompt and appropriate treatment, pubic lice can be eradicated effectively. It is crucial to follow the recommended treatment regimen and take preventive measures to prevent re-infestation. Additionally, addressing personal hygiene and practising safe sexual practices can help reduce the risk of pubic lice infestations.

Can pubic lice live on beards and other bodily hair?

Yes, pubic lice can infest other areas of the body with coarse hair, including the beard, chest, armpits, and even eyelashes. While they prefer the warm and moist environment of the pubic region, pubic lice can adapt to other body hair if necessary. Individuals with multiple areas of infestation may require thorough treatment of all affected areas to ensure complete eradication of the lice.

What does pubic lice look like?

Pubic lice are tiny insects, roughly the size of a pinhead, with crab-like claws adapted for grasping onto hair shafts. They are pale grey or tan in colour and may appear darker after feeding on blood. Pubic lice eggs, known as nits, are oval-shaped and often attached firmly to the base of hair shafts. Infestation may cause itching, redness, and irritation in the affected area.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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