STD - PUBIC LICE

Symptom Definition

Seeking information about pubic lice, a sexually transmitted disease (STD)

Typical Symptoms

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.

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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

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

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.
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 special nit comb or pull them out individually.
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.
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.
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.
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.
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.
Pregnancy Test When In Doubt: If there is any doubt about the possibility of pregnancy, then obtain and use a urine pregnancy test from the store.
Call Your Doctor If:
- Pregnancy test is positive; or if you have difficulties with the home pregnancy test
- You become worse or develop any of the "Call Your Doctor" symptoms.

References and Resources

American Social Health Association
- "Answers to your questions about teen sexual health and sexually transmitted diseases"
- http://www.iwannaknow.org
Sexually Transmitted Diseases Treatment Guidelines 2002. MMWR. 2002; 51(RR-6):1-80
Public Health Agency of Canada.
- Sexually Transmitted Infections (STI), Sexual Health Facts and Information
- http://www.phac-aspc.gc.ca/std-mts/faq_e.asp

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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.

Reviewed 10/1/2005

Revised 10/18/2005

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