PUBIC LICE

Symptom Definition

  • Itching of the pubic area is the main symptom.
  • Pubic hair contains gray bugs (lice) 1/16-inch long, that move quickly, and are difficult to see.
  • Nits (white or tan eggs) cemented to hair shafts near the skin (usually within 1/2 inch or 12 mm).  Unlike dandruff or sand, nits can't be shaken off the hair shafts.

General Information

  • Pubic lice are tiny wingless insects that live only on human beings.
  • The primary mode of transmission is via the skin-to-skin contact that occurs during sexual intercourse. Lice are very contagious. There is a 95% chance of transmission during a single episode of sexual intercourse. Rarely they may be transmitted via objects such as infected bed linens or toilet seats.
  • Pubic lice are annoying but cause no serious health problems.
  • They are also referred to as "crabs."
  • Up to 30 % of individuals with pubic lice also have another sexually transmitted disease.

WHEN TO CALL YOUR DOCTOR FOR PUBIC LICE

Call Your Doctor Now (night or day) If:

  • You feel weak or very sick

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If:

  • You think you need to be seen
  • Looks infected (e.g. pus, soft scabs, open sores)
  • More than 6 hours since completing treatment and moving lice are seen in the pubic hair
  • Pubic lice or nits recurs within 1 month
  • New or unusual vaginal discharge (e.g. odorous, yellow, green, or foamy-white)
  • White or yellow discharge from penis

Call Your Doctor During Weekday Office Hours If:

  • You have other questions or concerns
  • Pubic lice

HOME CARE ADVICE FOR PUBIC LICE (pending talking with your doctor)

  1. NIX: Buy Nix anti-lice creme rinse (permethrin).
    • Pour about 2 ounces of the creme into previously washed and towel-dried pubic hair. Add a little warm water to work up a lather. Be sure to work the creme into all the hair down to the roots.
    • Leave the Nix on for a full 20 minutes or it won't kill all the lice (10 minutes is not enough).
    • Then rinse the hair thoroughly and dry it with a towel. Repeat the Nix treatment in 1 week to kill any nits that were missed.
  2. Dead Nits: Wait 3 or more hours after Nix treatment is completed before removing the dead nits. (Reason: let Nix permeate the nits)  The nits can be loosened using a mixture of half vinegar and half warm water. After wetting the hair with this solution, cover the hair with a towel for 30 minutes. Then remove the dead nits by backcombing with a fine-tooth comb or pull them out individually.
  3. Pregnancy and Breastfeeding: Women who are pregnant or who are breastfeeding can be treated with products containing permethrin (e.g. NIX) according to the Centers for Disease Control.
  4. Contagiousness: Pubic lice are very contagious. Pubic lice are transmitted by skin to skin contact during sexual intercourse (they cannot jump). You should have no sexual intercourse until 2 weeks after successful treatment.
  5. Sexual Contacts: Any sexual partners that you have had during the last month will also need treatment, even if they don't see any obvious lice.
  6. Expected Course: With 2 treatments, all lice and nits should be killed. A recurrence usually means that there has been another contact with an infected person; the shampoo wasn't left on for 20 minutes; or the treatment wasn't repeated in 7 days. There are no lasting problems from having lice and they do not carry other diseases. Even after successful treatment, itching of the pubic area may persist for 1-2 weeks.
  7. Other Shampoos: If any of the pyrethrin anti-lice shampoos (A-200 Clear, R & C, Pronto or RID) are used, they must be applied to dry hair. Reapplication in 7 days to prevent re-infection is also required. Do not use these products if you are pregnant or breastfeeding.
  8. Call Your Doctor If:
    • You become worse or develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Adult HouseCalls Online. Copyright © 2000-2003 David Thompson, M.D. FACEP

Reviewed 8/2003

Revised 7/2002

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