Pubic Lice: Symptoms and Treatment

Globally, around 2 per cent of humans are thought to be infected with public lice, although in the UK the numbers have been decreasing in recent years, with sexual health clinics reporting fewer than 2000 cases every year. This doesn’t take into account people who go to their GP for advice, or self treat with over the counter remedies.

It can be anything from five days to a few weeks before any symptoms develop, and some people don’t notice anything at all. The most common symptoms are:

• Intense itching, normally in the pubic area
• A black powder-like substance in your underwear
• Tiny spots of blood, which can appear red or blue, on your skin, caused by bites

The most common symptom and probably the first thing you’ll notice is the itching, which is caused by a reaction to the lice saliva. It tends to get worse at night, when the lice are most active.

They can be quite hard to spot as the tiny lice are only 2mm long when fully grown. They are either a red colour or a grey/yellow and have six legs. They get their nickname ‘crabs’ or ‘crab lice’ from the two larger front legs that appear crab like - these allow the lice to cling on to the hairs.

Similar to head lice, the adult females lay their eggs in tiny sacs, the size of a pinhead, which stick to hairs. The eggs appear brown until they hatch, when the empty sacs appear white.

Pubic lice are common, can be easily treated and are nothing to be embarrassed about.

A sexual health clinic will be able to diagnose you straight away as they are familiar with the condition, but if there isn’t one near you, a GP or pharmacy will be able to help. The usual treatment for pubic lice is:

• permethrin cream (Lyclear)
• aqueous malathion (Derbac-M)

Don’t be tempted to try shaving the hairs off and ignoring the lice - they won’t go away unless you treat them. Shaving the infested areas won’t stop them coming back, as they only need a tiny amount of hair to lay their eggs.

Some treatments to be applied to your entire body, including beards, moustaches or hair around the anal region, as the lice spread very easily. Avoid the face, scalp or eye areas. Comb through with a fine tooth comb, to get rid of the eggs and leave the treatment on for 12 - 24 hours (according to the instructions) and repeat after seven days.

If you have lice in your eyelashes, don’t be tempted to treat them at home, see your doctor who will recommend a specialist eye ointment.

• Sometimes, pubic lice can build up a resistance to treatment, so if you notice any symptoms after the second treatment, visit your doctor or sexual health clinic.
• If you’re under 18, pregnant or breast feeding, don’t self treat, ask your doctor for advice.
• If you’re suffering from itching, you can take antihistamines to reduce your symptoms.

At the same time as treating yourself and anyone else in the household, wash all the sheets and bedding on a hot cycle (50 degrees or higher). Anything that’s hard to wash in a machine can be sealed in plastic bags which will also kill the lice. Don’t have sex again until you and your partner are completely louse-free.

It’s possible to have lice without noticing any symptoms, so you it’s important that you tell any people you share a home with as well as any sexual partners you’ve had recently to check themselves. Everyone needs to be treated, to stop the infestation coming back.

No. Public lice are smaller than head lice and are a different species.

No. Although they are usually spread through sexual contact, using condoms or other barrier types of contraception won’t protect you against pubic lice.

There have been fewer cases reported to sexual health clinics in recent years, and reports in the media have suggested that the incidence of pubic lice is falling because of the trend for removing all pubic hair in the last 15 years.