Pubic lice causes itching in the area covered by pubic hair. Itching often gets worse at night. The itching may start soon after getting infected with lice, or it may not start for up to 2 - 4 weeks after contact.
Other symptoms can include:
Skin reaction that causes skin to turn bluish-gray in color
Sores in the genital area due to bites and scratching
Exams and Tests
The health care provider will do an exam to look for:
Small gray-white oval eggs (nits) attached to the hart shafts in the outer genital area. Adult lice may also be present.
Scratch marks or signs of an infection, such as impetigo.
Because pubic lice may cause an eye infection (blepharitis) in young children, eyelashes should be viewed with a high-powered magnifying glass.
Adult lice may be easily identified under the microscope. Pubic lice are often referred to as "the crabs" because of their appearance.
Teenagers with pubic lice may need to be tested for other sexually transmitted infections (STIs).
Pubic lice are best treated with a prescription wash containing permethrin, such as Elimite or Kwell:
Thoroughly work the shampoo into dry pubic hair and surrounding area for at least 5 minutes.
Comb the pubic hair with a fine-toothed comb to remove eggs (nits). Applying vinegar to pubic hair before combing may help loosen nits.
Most people need only 1 treatment. If a second treatment is needed, it should be done 4 days to 1 week later.
Over-the-counter medicines to treat lice include Rid and Nix. Malathione lotion is another option.
While you are treating pubic lice:
Wash all clothing and bedding in hot water.
Spray items that cannot be washed may be sprayed with a medicated spray that you can buy at the store. You can also seal items in plastic bags for 10 - 14 days to smother lice.
Makes sure anyone with whom you have had sexual contact or shared a bed be treated at the same time.
People with pubic lice should be checked for other sexually-transmitted infections when lice are discovered.
The proper treatment, including thorough cleaning, should get rid of the lice.
Scratching can make the skin become raw, or even cause a skin infection.
When to Contact a Medical Professional
Call for an appointment with your health care provider if:
You or your sexual partner has symptoms of pubic lice
You try over-the-counter lice treatments and they are not effective
Your symptoms continue after treatment
Avoid sexual or intimate contact with people you know have pubic lice until they have been treated.
Bathe or shower often and keep your bedding clean. Avoid trying on bathing suits while you are shopping. If you must try on swimwear, be sure to wear your underwear. This may prevent you from getting or spreading pubic lice.
Diaz JH. Lice (pediculosis). In: Mandell GL, Bennett JE, Dolin R. Mendell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009:chap 293.
Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.