Pubic lice, also known as crabs, are tiny parasites that infect the pubic hair and other coarse hair on the body. Pubic lice infestations are common and spread easily through close personal contact. While pubic lice do not transmit disease, they can cause itching, irritation, and discomfort. Recognizing the signs and symptoms of pubic lice is important for getting effective treatment.
Common Symptoms
The most common symptom of pubic lice is itching in the pubic area and other areas with coarse hair. The itching, often described as prickly and intense, is caused by an allergic reaction to the saliva of the lice. The itching usually begins about 5 days after initial infestation and can continue for weeks after treatment if eggs remain viable. Excessive scratching can lead to skin irritation and even infection.
Other symptoms associated with pubic lice include:
- Visible nits (lice eggs) on hair shafts
- Adult lice visible in pubic hair or on underwear
- Blue-gray macules or spots on the skin caused by louse bites
- Difficulty sleeping due to itching
Pubic lice infestations can spread to other coarse body hair including legs, arms, chest, eyebrows, eyelashes, beard, mustache, armpits, and buttocks. All of these areas may develop itching and visible lice or nits if infested.
Who is at Risk?
Pubic lice are highly contagious through close personal contact and are spread most commonly through sexual activity. Factors that increase the risk of getting pubic lice include:
- Having multiple sex partners
- Having sex with an infected partner
- Sharing towels, clothes, or bedding with an infected person
- Close physical contact, hugging, kissing
While uncommon, it is also possible for pubic lice transmission to occur through shared toilet seats, saunas, or hot tubs. Good hygiene can help reduce transmission risk in these locations. Certain professions may also have increased exposure, such as nurses and childcare workers. Children can get pubic lice through hugging or close contact. Diagnosis is made through identification of live lice or eggs.
Complications
While pubic lice themselves do not cause serious medical problems, excessive scratching can lead to secondary issues including:
- Skin abrasions and infection
- Permanent skin discoloration
- Lichen simplex chronicus (thickened, discolored skin patches)
- Rarely, anaphylactic shock from louse bites
People with pubic lice should avoid excessive scratching to prevent these complications. Proper treatment and hygiene practices can eliminate lice and allow the skin to heal.
When to See a Doctor
Medical evaluation is recommended for the following:
- Severe itching in pubic area and other coarse hair regions
- Visible nits or lice in pubic hair or on clothing
- Skin irritation, redness, changes in pigmentation
- Itching that persists after attempted treatment
- Signs of skin infection like oozing, redness, heat, swelling
A doctor can clinically confirm the presence of pubic lice through visual inspection. They can also provide guidance on the proper topical medications and hygiene practices to eliminate the infestation. Seek prompt medical help if skin infections develop.
Home Treatment
The following steps may help provide relief and decrease transmission when pubic lice are suspected:
- Avoid sexual activity until treated to prevent spreading lice
- Wash infested areas daily with soap and water
- Cut nails short to discourage breaking the skin from scratching
- Apply over-the-counter hydrocortisone cream to reduce itching
- Apply a pediculicide medication according to label instructions
- Machine wash and dry clothing, towels, and bedding in hot water
Consult a doctor before using any medications, especially if pregnant or breastfeeding. Practice good hygiene and replace razors, underwear, hats, and other personal items that may have been contaminated.
Medical Treatment
Doctors can prescribe topical pediculicides to kill pubic lice:
- Permethrin – Applied to affected areas and washed off after 10 minutes. May require a second treatment in 7-10 days.
- Pyrethrins with piperonyl butoxide – Similar application as permethrin, repeated in 9-10 days.
- Spinosad – Applied to dry hair and washed off after 10 minutes. One treatment is often sufficient.
- Ivermectin – Oral medication that can be used for difficult-to-treat cases.
Repeat applications may be needed in some cases. OTC pediculicides containing lindane are no longer recommended due to toxicity concerns. All close contacts should be treated concurrently to prevent reinfestation and transmission.
Prognosis
With proper identification and treatment, most pubic lice cases can be successfully managed and cured. Topical pediculicides can effectively kill lice and nits with one or two applications. Itching may take 1-2 weeks to fully resolve even after lice are eliminated.
Diligent and thorough treatment is important, as missed eggs may hatch and restart the infestation. Hot laundering, daily grooming, and replacing potentially contaminated items can help prevent recurrence.
Refraining from sexual activity for at least one week after treatment can help prevent transmission and reinfestation. Sex partners should also be notified and treated appropriately.
Prevention
Preventing pubic lice involves avoiding activities that transmit lice from person to person. Recommendations include:
- Practice safe sex with barrier protection and minimize partners
- Avoid skin-to-skin intimate contact with potentially infected people
- Do not share clothing, towels, bedding with others
- Shower after potentially high-risk exposure in hot tubs or saunas
- Know the signs and get checked if you suspect exposure
Good personal hygiene including frequent bathing, daily clothes changing, and regular laundering can also help prevent transmission. Children should be taught to avoid head-to-head contact during play and avoid sharing hats, clothing, brushes, and other personal items.
Conclusion
Pubic lice cause irritating itching and visible nits in pubic hair and other body regions. They spread through close personal and sexual contact. Symptoms include intense itching starting around 5 days after exposure along with visible nits and lice. Complications like skin infections can occur from excessive scratching. Topical pediculicide medications can effectively kill lice with proper application. Preventing recurrence requires treating close contacts concurrently and taking preventive hygiene measures.