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Pubic lice Content Supplied by NHS Choices
Introduction

Pubic lice (Phthirus pubis) are tiny parasitic insects that?live on coarse human body hair, such as?pubic hair.

As well as being found in pubic hair, the?lice?are also sometimes found in:

  • underarm and leg hair
  • hair on the chest, abdomen?and back
  • facial hair, such as beards?and moustaches
  • eyelashes?and eyebrows?(very occasionally)

Unlike?head lice, pubic lice don't live in scalp hair.

Pubic lice are spread through close bodily contact, most commonly sexual contact.

Symptoms of pubic lice

After getting pubic lice, it can take several weeks before any symptoms appear. Symptoms are the same for men and women and include:

  • itching?in the affected areas
  • inflammation and irritation caused by scratching
  • black powder in your underwear
  • blue spots or small spots of blood on your skin, such as on your thighs or lower abdomen (caused by lice bites)

Itching?is the most common symptom of pubic lice and is an allergic reaction?to their saliva. The itching?is usually worse at night, when the lice are most active.

What do pubic lice look like?

Adult pubic lice are very small (2mm long) and aren't easy to see. They're a yellow-grey or dusky red colour and have six legs.

Pubic lice are sometimes known as crabs because they have two large front legs that look like the?claws of a crab. These are used to hold onto the base of hairs.

The lice lay their?eggs?(nits)?in sacs that are stuck firmly to hairs and are a pale brownish colour. When the eggs hatch, the empty egg sacs are white.

Although pubic lice and lice eggs are small and difficult to see, they may be visible in coarse hair anywhere on your body (apart from hair on your head).

When to seek medical advice

See your GP or practice nurse if you think you have pubic lice. Alternatively, you could go to a?sexual health clinic,?also known as a genitourinary medicine (GUM) clinic. These are often located in hospitals or health centres.

Search for?sexual health services in your area.

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.

Getting tested for STIs

You should be tested for other sexually transmitted infections (STIs)?if you have pubic lice through sexual contact. The?lice don't transmit?HIV or other STIs, but a check-up is usually recommended as a precaution.?

Any sexual partners you've had over the last three months will also need to be seen and treated. If you prefer, staff at the clinic can contact a person on your behalf without releasing your details.

How?do you?get?pubic lice?

Pubic lice aren't related to poor personal hygiene.?They're usually spread through close bodily contact with an infected person.

The lice crawl from hair to hair, but can't fly or jump. They need human blood to survive, so will only leave the body to move from one person to another.

The most common way pubic lice are spread is through sexual contact, including vaginal, anal and oral sex. 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 much rarer - for pubic lice to be spread through sharing clothes, towels?and bedding.?

Treating pubic lice

Pubic lice?can be treated at home with insecticide cream, lotion or shampoo. Your GP or pharmacist?can advise you?about which treatment to use and how to use it. It's important to follow this advice.

Some?treatments only need to be applied to the affected area, but sometimes the whole body must be treated, taking care to avoid the eyes. The treatment usually needs to be repeated after?three to seven?days.

If the treatment doesn't work, you may need to use?another type. This is because?pubic lice can develop resistance to some treatments. Your GP or pharmacist will be able to advise you about suitable?alternatives.

To prevent re-infestation,?anyone you've had close bodily contact with, including any sexual partners you've had in the past three months, should also be treated, even if they don't have symptoms.

Certain groups, such as young people under 18 years of age and pregnant or breastfeeding?women, may require a specific type of treatment.?Ask your GP or pharmacist for further advice about this.

Applying a lotion, cream or shampoo

In most cases the instructions for using a?lotion, cream or shampoo will be as follows:

  • apply the?product to?the affected area, particularly any hairy areas, such as your eyebrows, beard or moustache?- depending on the product,?you might need to apply it?to your whole?body, including the scalp, neck, ears and face
  • be careful not to get the?product in your eyes?- if you do, rinse your eyes thoroughly with water
  • reapply the treatment if you wash any part of your body during the treatment time
  • after the treatment time?(stated on the packet)?has passed, wash the lotion or cream off
  • repeat the treatment after?three to seven?days as instructed

Don't use the medication more than twice. If you think it hasn't worked go to see your GP or pharmacist for advice.

Side effects

Insecticides used to treat pubic lice may cause skin irritation, such as itchiness, redness, stinging or burning. If you have skin irritation, wash the insecticide off the affected area.

Some aqueous and alcohol-based medications may discolour permed, coloured or bleached hair. Check the patient information leaflet.

Follow-up treatment

The first treatment application will probably kill the lice, but the eggs may not have been destroyed. This means more lice could hatch and the cycle will start again.

Reapplying the treatment after three or seven days will ensure that any lice?are?killed before they're old enough to lay more eggs.

Check for lice a week after your second treatment, or return to your GP, practice nurse, or sexual health clinic so they can check for you.

Finding?empty eggshells (dead nits) doesn't necessarily mean you're still infested as they?can remain stuck to the hairs even after treatment.

Treating an eyelash infestation

Eyelash infestations are rare. If your eyelashes are infested, seek specialist advice from your doctor. They'll?be able to recommend the correct treatment for you.?

You can't use the same insecticide lotion or cream?that's used on your body because it will irritate your eyes.?Make sure you?follow the treatment instructions carefully.

Washing clothing, towels?and bedding

Wash clothing, towels and bedding in a washing machine. This should be on a hot cycle (50C or higher) to ensure the lice are killed and to prevent reinfection.

Complications of pubic lice

Sometimes, a pubic lice infestation can lead to minor complications, such as skin or eye problems.

Scratching can irritate your skin, or it could 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 with pubic lice.

Seek medical advice if you have severe skin irritation or sore eyes.

Symptoms of pubic lice

After you come into contact with pubic lice, it can take several weeks before symptoms appear. Some people don't have any symptoms, or may not notice them.

The symptoms of pubic lice are the same for both men and women, and include:

  • itching in the affected areas, which may be intense
  • inflammation and irritation in the affected areas caused by scratching
  • black powder in your underwear
  • blue-coloured spots on your skin where the lice are living, such as on your thighs or lower abdomen (these are caused by lice bites)
  • small spots of blood on your skin that are also caused by lice bites

Itching

Itching is the most common symptom of pubic lice. However, it can take several weeks after the first infestation for you to notice any itching.

The itching is not caused by the lice biting you - it's an allergic reaction to the louse saliva.

The itching is usually worse during the night, when the lice are more active.

Pubic lice and eggs

Adult pubic lice are very small (about 2mm long) and difficult to see. The lice are yellow-grey or dusky red in colour and have six legs.

Two of the legs are larger than the others and look like the claws of a crab. The lice use these to grasp onto hairs.

The lice lay their eggs (nits) in sacs that are firmly stuck to hairs and are a pale brownish colour. When the eggs hatch, the empty sacs are white.

Although pubic lice and lice eggs are very small and not easy to see, they may be visible in coarse hair anywhere on your body (apart from the hair on your head).

You may also find empty white eggshells on your hairs, although this does not necessarily mean that you still have an infestation of pubic lice.

Causes of pubic lice

Pubic lice are not related to poor personal hygiene. They are usually caught through close bodily contact with someone who is infected.

The lice can be found in hair almost anywhere on the body, such as beards, underarm hair and leg hair.

However, unlike head lice, they do not usually live in hair on the head.

Pubic lice crawl from the hair of one person to the hair of another person. They cannot jump, fly or swim.

Sexual contact

Pubic lice are most commonly passed on through sexual contact. This includes vaginal, anal and oral sex.

Using condoms and other methods of barrier contraception does not protect you against pubic lice.

Other types of close bodily contact, such as hugging and kissing, can also spread the lice.

Other ways of spreading pubic lice

It is also thought that you can get pubic lice from infected items, such as:

  • clothing
  • bed linen
  • towels
  • toilet seats

However, it's much rarer for lice to be spread in this way.

The life cycle of pubic lice

Pubic lice live for one to three months. During this time, the female louse can lay up to 300 eggs. The eggs hatch after 6 to 10 days, and the lice reach maturity and can start reproducing two to three weeks later.

When not on a human body, pubic lice can live for around 24 to 48 hours. However, the lice depend on human blood to survive, so they rarely leave the body other than to move to another person. Pubic lice do not live on other animals.

Diagnosing pubic lice

If you think you have pubic lice, get checked as soon as possible.

You can go to:

  • a sexual health clinic, also called a genitourinary medicine (GUM) clinic
  • a contraception clinic
  • your GP surgery to see your GP or practice nurse

Sexual health and GUM clinics are often located in hospitals or health centres. Search for sexual health services in your area.

You can also search for GUM clinics in your area on the British Association for Sexual Health and HIV (BASHH) website.

In many cases, a healthcare professional will be able to confirm that you have pubic lice by examining the affected area. They may use a magnifying glass to look for:

  • yellow-grey or dusky red-coloured lice
  • brown lice eggs or empty white eggshells (nits)

If you find nits, it does not necessarily mean that you still have an active infestation, although you may still be offered treatment.

Getting tested for STIs

If you already know that you have pubic lice, your local pharmacy can offer advice and treatment.

However, if the pubic lice were transferred through sexual contact, it may be recommended that you are tested for other sexually transmitted infections (STIs) as a precaution.

It will also be recommended that all your sexual partners over the last three months are seen and treated.

'When my GP said I had pubic lice, I was revolted'

Elise Houghton had pubic lice when she was 17.

"I had gone on holiday with some girlfriends for the summer and had been away for about a week when I started getting symptoms. I was really itchy around the pubic area and had a bit of a rash. At first, I didn't think anything of it, but after a few days the itching got worse. I couldn't work out what was wrong, but a friend suggested I go to the doctor.

"It was really embarrassing going to the doctor, and when she said it was pubic lice I felt revolted. The thought of them turned my stomach and it made me feel really dirty.

"The doctor told me how they were passed on through sexual contact and I realised I must have got them from someone I'd had a short fling with just before I left to go on holiday. It made me feel a bit sick.

"I was given special cream to kill the lice and their eggs, and I had to do two treatments. It was quite difficult keeping it quiet from my friends, but I didn't really want them to know. I felt so embarrassed about it. I was still itching after treatment and I was really worried that it hadn't worked, but when I went back to the doctor, she said that was normal and it would calm down, which it did.

"Catching pubic lice made me much more careful about my sexual health. When I got home from holiday, I went to a sexual health clinic and had a full check-up. I was worried that if I had caught pubic lice, I could have caught something else.

"Thankfully, I got the all-clear, but since then I have become much more careful."

Treating pubic lice

Pubic lice can be treated at home with insecticide cream, lotion or shampoo. It will usually need to be applied once and repeated after three to seven days.

Some treatments only need to be applied to the affected area, but sometimes the whole body must be treated, taking care to avoid the eyes. Your doctor, nurse or pharmacist can give you more advice about this.

Everyone you have had close bodily contact with should also be treated at the same time. This includes any sexual partners you have had in the past three months and all members of your household.

Sometimes pubic lice can be difficult to get rid of because they can develop resistance to insecticide treatments. If this is the case, you may need to try more than one type of treatment. Your doctor or pharmacist can advise you on suitable alternatives.

Washing clothing and bedding

It's important to wash any clothing and bedding, including towels, in a washing machine. This should be on a hot cycle (50 C or higher) to make sure the lice are killed to help prevent reinfection.

Treating yourself

You can treat yourself at home with an insecticide cream, lotion or shampoo. They are available on prescription from your doctor, or you can buy them over the counter from your pharmacy.

Before using the treatment, speak to your doctor or pharmacist about the correct way to use it. Follow their instructions, even if they are different to those on the packaging.

Always ask for advice if the treatment is for:

  • a child under 18 years of age
  • someone who is pregnant or breastfeeding

These people may require a specific type of treatment.

Applying a lotion, cream or shampoo

In most cases the instructions for using a lotion, cream or shampoo will be as follows:

  • apply the product to the affected area, particularly any hairy areas, such as your eyebrows, beard or moustache - depending on the product, you might need to apply it to your whole body, including the scalp, neck, ears and face
  • be careful not to get the product in your eyes - if you do, rinse your eyes thoroughly with water
  • reapply the treatment if you wash any part of your body during the treatment time
  • after the correct treatment time (stated on the packet) has passed, wash the lotion or cream off
  • repeat the treatment after three to seven days as instructed

Do not use the medication more than twice.

Treating an eyelash infestation

If your eyelashes are infested, seek specialist advice and help from your doctor.

You cannot use the same insecticide lotion or cream that you use on your body as this will irritate your eyes. Your doctor will be able to recommend an alternative treatment for you.

Eye ointment

An eye ointment with a white or yellow soft paraffin base may be recommended. This works by coating the lice in the greasy ointment and suffocating them. You should:

  • apply the ointment to your eyelashes twice a day, ensuring that all your eyelashes are well covered
  • each time you reapply the ointment, first gently wipe your eyelashes and eyelids clean with a tissue, and throw the tissue away afterwards
  • continue the treatment for at least eight days
  • continue the treatment for 10 days if you can still see lice or unhatched eggs (not empty eggshells or dead nits) - the eggs can take this long to hatch

Side effects

Insecticides that are used to treat pubic lice may cause skin or eye irritation, such as itchiness, redness, stinging or burning.

If you have these side effects, wash the insecticide off the irritated area. If the insecticide gets into your eyes, rinse them thoroughly using plenty of water.

Some aqueous and alcohol-based medications may discolour permed, coloured or bleached hair. Check the patient information leaflet for more details.

Follow-up treatment

The first treatment application will probably kill the lice, but the eggs may not have been destroyed. This means that more lice could hatch and the cycle will start again.

Reapplying the treatment after seven days ensures that any lice are killed before they are old enough to lay more eggs.

Check for lice a week after your second treatment, or return to your doctor, sexual health clinic or genitourinary medicine (GUM) clinic so they can check for you.

If you find empty eggshells (dead nits), it does not necessarily mean that you are still infested. They can remain stuck to the hairs even after treatment.

Sometimes lice may be resistant to the treatment used and your doctor may recommend a different treatment.

Treating other people

To prevent reinfestation, anyone that you are in close contact with should also be treated at the same time as you. This includes your sexual partners and all members of your household, even if they do not have symptoms.

Infestations from sexual contact

Your GP may refer you to a GUM clinic so you can be screened for other sexually transmitted infections (STIs), such as chlamydia.

Staff at the clinic will recommend that you inform any sexual partners you have had in the past three months so they can also be examined for pubic lice and treated if necessary.

Some people feel angry, upset or embarrassed about talking to their current or former sexual partners about pubic lice. Do not be afraid to discuss your concerns with clinic staff. They can help you decide the best way to make contact. They can also contact a partner without releasing your details, if you prefer.

 
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