Pubic Lice

What are pubic lice and body lice?

Pubic lice (Phthirus pubis) are very small grey or brown insects that are only 1- to 2-mm in length. They are commonly known as ‘crabs’ as their second and third leg pairs have crab-like claws to hold tightly onto hairs. Lice survive by feeding on your blood (which they get through biting your skin) as they are blood-sucking insects. Female lice lay tiny eggs (which are also called ‘nits’) that are much smaller than a pinhead. The eggs stick to the hairs where the lice are living and hatch into lice in about 6 to 10 days. One female louse can live for 1 to 3 months and can lay 300 eggs in her brief life.

Pubic lice prefer thick, coarse hair and live in the hairy areas of your body, but not in the hair on you head, as this is softer, finer hair that the lice have trouble holding on to. (Lice in the hair are a different species to pubic lice and are called Pediculus humanus capitis.) Thus, pubic lice usually affect pubic hair, but may also affect other body hair, for example, around your anus (back passage), beard, underarms, chest and, occasionally, even your eyebrows and eyelashes.

Body lice are longer than pubic lice are (at around 3 to 4 mm) but with a narrower body. Their medical name is Pediculus humanus. They are also called ‘clothing lice’ as the lice, along with their eggs, can often be found in the seams of your clothing. Body lice can live anywhere on your body but they tend to avoid your scalp, except at its margins.

Your IPSA clinic pubic and body lice consultation

You can be assured that IPSA always operates in a completely confidential manner and that IPSA always provides a discrete and comfortable setting for any examinations that are required. Your IPSA practitioner will treat you holistically and will employ a person-centred approach to your consultation. Your IPSA physician will be skilled and experienced in both diagnosing and treating pubic and body lice and will discuss the best treatment options with you at the time of your consultation prior to deciding on the best treatment plan.

How do you ‘get’ pubic lice?

Passing public lice on to other people requires close body contact and usually you ‘catch them’ by having sex with someone who has an infestation of pubic lice.

It is also possible to ‘catch’ these lice following close but non-sexual physical contact with a person who is affected (for example, by kissing someone with lice in their beard).

As pubic lice (and the eggs) do attach strongly to coarse hair, they do not simply wash off, brush off or fall of. Pubic lice cannot survive very long without their human ‘host’ from which to feed, so you are highly unlikely to catch them from shared towels, clothing, bed linen or toilet seats.

How do you ‘get’ body lice?

These lice can be caught through close physical contact (and not necessarily just sexual contact) with a person who has body lice. You can catch body lice from lice-infested bedding, clothing or towels. Homeless people often have body lice when they are unable to change their clothes or wash frequently.

What are the symptoms of lice?

Pubic lice

The most usual symptom of pubic lice is a generalised itching in any affected areas (usually your pubic hair region). Itching might take anywhere from one to three weeks to start after you have become infected. This itching usually gets worse at night as this is when the lice are feeding. The itching is caused by sensitivity to the louse saliva.
Sometimes itchy red ‘bumps’ appear in the hair-covered areas on your skin.
Where the lice have been feeding off you, you may see faint blue spots on your skin.
Due to scratching and the skin irritation, you may experience a rash or some redness in the affected areas.
If your eyelashes become infested then this may result in eye inflammation.
Sometimes, tiny, dark-brown specs can be seen on your skin or in your underwear, which is the faeces (poo) of the pubic lice.
Some people who have no symptoms can still pass the lice on to other people without realising it.

Body lice

Some people do not have symptoms from body lice, but notice lice (or nits) on their clothes or on their body.
It is common to itch at night, especially in the trunk region, the armpits or around the groin, as the body lice live on your clothes through the daytime and only move onto your skin at night to feed on your blood.
You may also notice small red lumps and/or blue spots on your skin.

How does IPSA treat lice?

Pubic lice

During your IPSA pubic (and/or body) lice consultation, your IPSA physician will assess and discuss with you the best type of treatment for your lice. The first line of treatment is usually an insecticide that is specially formulated to kill pubic lice on the human body. In this case, your IPSA doctor will explain how your whole body will have to be treated twice (with a seven-day interval between the first and second applications), and how it is important not to get the insecticide in your eyes.

Two insecticides are usually used to treat pubic lice: malathion lotion (Derbac-M®, Quellada-M®) or permethrin 5% cream (Lyclear® Dermal Cream). Alcohol-based products can cause further skin irritation, so aqueous (water-based) products are preferred. These lotions and creams are easy to apply and, if used properly, usually work well.

Your IPSA clinician will run through the guide for successful application/treatment with you:

Malathion is suitable for all ages.
If you are under 18, then permethrin is not usually used.
Both the lotion and cream must be applied to your entire body (and that includes your scalp), because the pubic lice can spread to affect many parts of your body, sometimes even infecting your scalp. You should be especially careful to ensure you cover the hairy parts of your body with the lotion/cream, especially your pubic hair, the hair around your anus (back passage), your beard, moustache and your eyebrows. Your IPSA physician will explain the procedure to you in detail and highlight the danger in getting the cream or lotion into your eyes.
An average adult requires approximately 20 to 30 grams of cream or 100 ml of the lotion to cover their whole body.
Apply the lotion/cream to dry and cool skin. If you have had a hot shower or bath then wait until your skin is completely dry and has cooled down before application.
The lotion or the cream needs to be left on for the recommended time and then washed off. Malathion needs to be left on for 12 hours (overnight), then washed off, while permethrin 5% dermal cream needs to be left on for 24 hours, then washed off.
If you do wash any part of your body in the treatment period, you need to reapply the lotion/cream again to those washed areas.
The affected areas do not need to be shaved as the lotion/cream will clear your pubic lice.
Some people wash all their bed linen, clothes (particularly their underwear) and towels that have been used form a week prior to the symptoms having started, although there is no strong evidence it is necessary (but some people do prefer to do this as an extra precautionary measure).
Your IPSA physician will advise you on possible treatments if your eyelashes are infected with pubic lice; often, a simple eye ointment (or Lacri-Lube® ointment) which is greasy, rather like Vaseline®, is applied to the eyelashes using cotton buds and this suffocates the pubic lice.
Some treatments might not be appropriate for you if you are pregnant/breast-feeding, and your IPSA doctor will discuss that with you during your consultation.

After a seven-day period, the same treatment is carried out again, as although the pubic lice may all be dead, not all of the lice eggs may have been killed during your first application, so the second application ensures any lice that have hatched from the eggs that survived your first application are killed before they are able to lay further eggs.

Body lice

As body lice mostly live in clothing and in your bedding, skin applications are less important. The main treatment your IPSA doctor will discuss with you is targeted at destroying the nits/lice in your clothing and bedding. This means laundering your clothing/bedding in hot water (at least 130°F), then ironing using a hot iron, followed by drying in a hot dryer or by dry cleaning. If you have many body lice present then an insecticide might need to be applied directly onto your body.

If the outbreak is in a community, then your clothing and bedding might be treated using an insecticide.

Do my family and friends need treated for lice?

Pubic lice

Recent close contacts/sexual partners (those from within the last three months) should also be examined and treated if they are found to be infected with pubic lice. (Don’t forget that you can have pubic lice with no symptoms.)

Body lice

People who have been in contact with the body, bedding or clothing of someone infected with body lice need to be examined for lice and treated, if appropriate. Ideally, their clothing/bedding should be treated and they should improve their hygiene routine.

Other points concerning pubic lice

Itching sometimes takes a couple of days to settle down following successful treatment.
If your symptoms do persist following the second lotion/cream application, then speak again to your IPSA physician as this is often because the pubic lice are resistant to a particular insecticide and you may require a different insecticide.
Avoid any close bodily contact with others until after you have finished the second cream/lotion treatment application.
If you did catch pubic lice from a sexual contact, then you need to be tested for other STIs. Your IPSA doctor will do this for you, if appropriate.

To book your pubic lice/body lice same-day IPSA consultation, simply phone in or book online.