Pubic Lice

Lice or crabs are tiny insects that are about the size of a pinhead. Pubic lice infect the groin area. They cause bite marks and itching, especially at night. Lice lay eggs called nits that look like tiny white specks. The nits stick to pubic hairs. They don’t brush away or wash off. To live, adult lice must feed on blood. Lice that fall off a person will die in 1 to 2 days.

Lice are easily spread by sexual contact with an infected person. But you can also get them from sharing personal items such as clothing, towels, and bedding.

Pubic lice are almost always in the pubic area. But pubic lice can be found in any hairy area. These areas include armpits, leg hair, chest, belly (abdomen), back, eyelashes, or eyebrows.

Pubic lice symptoms include:

  • Crawling feeling in your hair

  • Itching that is caused by an allergic reaction to the saliva of the lice (itching alone doesn't mean you have lice)

  • Red bumps around your pubic hair

  • Sores from scratching

  • You see the lice

  • Tiny brown specks in your underwear (lice feces)

  • Blood spots in your underwear

  • Faint blue spots on the skin from the lice feeding

Home care

Medicine

Pubic lice require medicine to kill the lice. There are both prescription and non-prescription medicines that can be used. When using the medicine, it must be used on the whole body, including the scalp.

There is an over-the-counter medicated cream rinse that is often used to treat head lice. It's usually effective. But lice are developing some resistance to it. If you see live lice after a second treatment, talk to your healthcare provider.

Here are some cautions:

  • Don't use the medicine around your eyes. If it gets in your eyes, wash your eyes out thoroughly.

  • Don't use it inside the nose, ear, mouth, vagina, or on the eyebrows or eyelashes.

  • Talk with your provider before using this if you are pregnant or breastfeeding, or if you are planning to use it on a child younger than age 2.

If your provider recommends a medicated cream rinse, use it as follows:

  • Wash the infested area .

  • Rinse with water and then towel dry. The towel will need to be washed. There could be lice on it.

  • Let your body cool down, if the shower was hot.

  • Carefully follow the instructions that come with the medicine.

  • Put on enough medicated cream rinse to soak the entire body except as noted above.

  • Rinse well after 10 minutes. Leaving it on longer won't make it work better.

  • You then need to remove the nits using a special fine-toothed comb called a nit comb. You can usually get one in a pharmacy or one comes in the kit.

  • Stroke the comb through 1 section of the hair at a time, from skin to hair tip. Clean the comb after each stroke. 

  • Put on clean underwear and wash the infested ones in hot water.

When treating lice and nits on the eyebrows or eyelashes:

  • If there aren’t a lot of lice, it's sometimes possible to remove them with a nit comb

  • Other treatments can be done using ophthalmic-grade petrolatum ointment. This is only available by prescription. Apply this to the edge of your eyelids 3 to 4 times a day for 10 days. This kills the lice by smothering them. Don’t use regular petroleum-like ointments. They can irritate the eyes.

Medicine for symptoms

Itching probably causes the most discomfort. Over-the-counter antihistamines that have diphenhydramine are sold at pharmacies and grocery stores. Use an antihistamine in pill form, not a cream. If you were not given a prescription antihistamine, then you may use an over-the-counter version to reduce itching if large areas of the skin are involved. This medicine may make you sleepy. So use lower doses during the day and higher doses at bedtime. Some antihistamines make you less sleepy. These are a good choice for daytime use.

Note: Don't use antihistamines with diphenhydramine if you have glaucoma or if you are a man with trouble urinating because of an enlarged prostate. You may have been given antibiotics because a bacterial infection developed usually from scratching, not from the lice. Take the antibiotics until they are finished. It's important to finish them even if the wound looks better. This help make sure that the infection has cleared.

General care

As you treat your pubic lice, also follow these steps:

  • Machine-wash all your underwear, hats, scarves, clothes, bed linens, and towels in hot water.

  • Dry on the hot cycle of the dryer. Any clothing, bed linens, or stuffed animals that can’t be washed this way should be dry-cleaned or sealed in a plastic bag for 2 weeks. Lice will die during this time.

  • If possible, vacuum all rugs, carpets, and mattresses that were used while you were infected.

  • Sex partners and household members should be treated at the same time to prevent re-infection.

  • Don't have sexual contact until rechecked by your healthcare provider to confirm that all lice are gone.

Follow-up care

Follow up with your healthcare provider, or as advised. Call your provider if you are still itchy or if you see live lice in your pubic hair 7 days after the first treatment. If you have been infected with pubic lice, you should also be checked for other sexually transmitted infections.

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Itching gets worse and is not relieved by oral antihistamines

  • Increased tenderness, swelling of the skin, or pus draining from the bite

  • Trouble breathing

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