Pubic lice (crabs)

Pubic lice, often called 'crabs', are tiny insects that live in coarse  body hair, most commonly pubic hair.

They feed on small amounts of blood and can cause itching and skin irritation. Pubic lice are different from head lice.

They can also sometimes be found in other coarse body hair, such as underarm hair, chest hair, beard hair, eyebrows or eyelashes.

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Pubic lice are usually passed on through close body-to-body contact, most commonly during sex.

They crawl from hair to hair. They do not jump or fly.

It is less common, but possible, to get pubic lice from sharing bedding, towels or clothing with someone who has pubic lice.

Condoms and oral dams do not reliably prevent pubic lice because they do not cover all areas of pubic hair or skin contact.

Symptoms may include:

• Itching around the pubic area, often worse at night
• Small red or blue spots on the skin
• Tiny bit marks or spots of blood
• Dark brown specks in underwear
• Visible lice or eggs attached to pubic hair
• Skin irritation or redness from scratching
• Red or irritated eyes if eyelashes are affected.

Some people notice symptoms within a few days, but for others it may take longer.

Pubic lice are not usually serious and are easy to treat.

They no not cause cancer and they are not a sign of poor hygiene.

The main problems are itching, irritation, scratching, and occasionally a secondary skin infection. If pubic lice are found in the eyelashes, or if symptoms are severe or not improving after treatment, seek medical advice.

There is no blood test or urine test for pubic lice.

A doctor, nurse or pharmacist can usually diagnose pubic lice by looking closely at the affected hair and skin. A magnifying glass may be used to see lice or eggs more clearly.

If you have pubic lice, it is also a good idea to have a sexual health check, as other STIs can be present at the same time.

Pubic lice are treated with a medicated cream or lotion, commonly permethrin.

Treatment is usually applied to the affected hairy areas of the body, following the instructions carefully. Do not use pubic lice treatment near the eyes. If eyelashes are affected, seek medical advice.

You may need a second treatment 7-10 days later, depending on the product used and whether live lice are still present.

It is important to:

• Follow the instructions exactly
• Treat sexual partners or close contacts if advised
• Wash recently used clothing, bedding and towels
• Avoid sex or close body contact until treatment is completed and there are no live lice.

Egg casings, also called nits, may remain attached to hairs after treatment even when the lice are dead. These can be removed with a fine-toothed comb if needed.

To main way to prevent pubic lice from coming back is to make sure sexual partners and close contacts are checked and treated if needed.

Avoid close body contact or sex until treatment has worked and there are no live lice.

Wash bedding, towels and clothing used recently. Items that cannot be washed can be put aside in a sealed bag for a few days.

Condoms are still important for reducing the risk of many STIs, but they do not reliably prevent pubic lice.

If you have pubic lice, it is important to tell recent sexual partners so they can check themselves and get treatment if needed.

This helps prevent passing pubic lice back and forth.

A sexual health clinic, nurse or doctor can help you with this if you are unsure what to say.