STD - Pubic Lice

Symptoms

DEFINITION

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

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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.

Additional Resources

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

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See More Appropriate Topic (instead of this one) If

• How to PREVENT a sexually transmitted disease
• PENIS SYMPTOMS (male genital symptoms)
• VULVAR SYMPTOMS (female genital symptoms) 
• Questions about CHLAMYDIA, a sexually transmitted disease
• Questions about GONORRHEA, a sexually transmitted disease
• Questions about HIV EXPOSURE, a sexually transmitted disease
• Questions about GENITAL HERPES, a sexually transmitted disease
• Questions about TRICHOMONAS, a sexually transmitted disease

Should I Call?

WHEN TO CALL YOUR DOCTOR

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

Care at Home

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 onto 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).
   • 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 special nit comb or pull them out individually.
3. Pregnancy and Breastfeeding: According to the Centers for Disease Control, women who are pregnant or who are breastfeeding can be treated with products containing permethrin (e.g., NIX).
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. Pregnancy test, when in doubt:
   • If there is any possibility of pregnancy, obtain and use a urine pregnancy test from the local drug store.
   • Follow the instructions included in the package.
9. STD National Hotline
   • The CDC National STD Hotline provides information on sexually transmitted diseases (STDs), such as chlamydia, gonorrhea, HPV/genital warts, herpes, and HIV/AIDS. Specialists can provide general information, referrals to local clinics, and written materials about STDs and disease prevention.
   • Toll-free number (English): (800) 227-8922
   • Toll-free number (Spanish): (800) 344-7432
   • Their website is at: http://www.ashastd.org/
10. Call Your Doctor If:
    • Pregnancy test is positive or if you have difficulties with the home pregnancy test
    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Photo Example

Pubic Louse

This is an enlargement of a Phthirus pubis, or more commonly known as the pubic or crab louse.

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

The photo shows pubic lice in the pubic hair of groin area. Pubic lice are tiny wingless insects that live only on human beings. The are also called "crabs".

Typical symptoms of pubic lice are:

• 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.

Pubic lice are very contagious:

• The primary mode of transmission is via the skin-to-skin contact that occurs during sexual intercourse. There is a 95% chance of transmission during a single episode of sexual intercourse.
• Rarely they can be transmitted via objects such as infected bed linens or toilet seats.