If you have pubic lice (crabs), you may experience:

• Itching. You may have intense itching in your pubic region.
• Lice in your pubic hair. These lice may spread to your upper thighs, stomach, chest and beard. In children, pubic lice may infest the eyelashes. Pubic lice are about 0.08 to 0.12 inches (2 to 3 millimeters) in size.
• Lice eggs (nits) on hair shafts. Nits resemble tiny pussy willow buds, though much smaller. Nits can be mistaken for dandruff, but unlike dandruff, they can't be easily brushed out of hair.
• Genital lesions due to bites. Small, red bumps can occur and you may have marks from scratching due to itching.

When to see a doctor
Usually you can get rid of pubic lice by taking self-care steps that include using a nonprescription shampoo, such as Rid or Nix, that's specifically formulated to kill lice.

However, see your doctor if:

• Nonprescription shampoo doesn't kill the lice (your doctor can prescribe a stronger shampoo)
• You're pregnant (don't use any anti-lice shampoo until you talk to your doctor)
• You have any infected skin abrasions from scratching

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Pubic lice are different from the lice found in a head or body lice infestation. Pubic lice infestations are caused by exposure to pubic lice or their eggs through:

• Sexual activity. A pubic lice infestation is most commonly caused by transmission of lice during sexual activity. If exposed to pubic lice during sex even once, you are more than 90 percent likely to get an infestation.
• Contaminated objects. Although rare, you may also acquire pubic lice from contaminated sheets, blankets, towels or clothes. It's possible to be exposed while trying on bathing suits when shopping. Young children exposed to heavily infested adults may develop a pubic lice infestation in their eyelashes and eyebrows.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

You are at higher risk of pubic lice if you:

• Are a sexually active adolescent (the condition is most common in adolescents)
• Have multiple sex partners
• Have sex with someone infested with pubic lice
• Share bedding, towels or clothing with someone infested with pubic lice

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Pubic lice infestations can usually be treated with few problems. However, a pubic lice infestation sometimes leads to complications such as:

• Inflammatory skin reactions. Pubic lice bites may cause an inflammatory skin reaction that results in small, flat gray-blue colored bumps called maculae ceruleae. These may appear as a result of altered blood pigment.
• Secondary infections. When pubic lice scratch and dig to feed on your blood, they may irritate your skin. If you scratch to alleviate itching, this can also irritate your skin. If your skin becomes raw from these irritations, other infections may develop.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Usually you can get rid of pubic lice by using a nonprescription shampoo, such as Rid or Nix, that's specifically made to kill lice. Properly washing potentially contaminated sheets, towels and clothes also helps to eliminate pubic lice.

If these measures don't work, see your family doctor or a general practitioner. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including when you might have been exposed to pubic lice, who you might have exposed, and what bedding or clothing items might be contaminated.
• Bring a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For pubic lice, some basic questions to ask your doctor include:

• How do I treat pubic lice?
• Is there a generic alternative to the medicine you're prescribing me?
• How do I rid my household items of pubic lice?
• Who do I need to inform about my condition?
• How long should I avoid sexual contact?
• What other measures do I need to take to avoid re-infesting myself or others?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may save time, allowing more time later to cover points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• How were you exposed to pubic lice?
• Is there anyone you might have exposed to lice?

What you can do in the meantime
If you think or know you have a pubic lice infestation, avoid sexual activity until you've been treated. Also avoid sharing bedding, towels or clothing.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

You or your doctor can usually confirm a pubic lice infestation through a visual examination of your pubic area. Using a magnifying glass may help. The presence of moving lice confirms infestation.

Lice eggs (nits) also may indicate an infestation. However, nits can cling to hairs and be present, although no longer alive, even after successful treatment.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Pubic lice can be treated with the same nonprescription and prescription treatments used for head lice.

Medications

• Over-the-counter lotions or shampoos (Nix, Rid, others). These products are usually the first line of defense. However, if nonprescription products don't kill the lice, your doctor can prescribe a stronger shampoo or lotion.
• Malathion (Ovide). You apply this prescription lotion to the affected area and wash it off after eight to 12 hours. Malathion is flammable, so keep it away from heat sources such as hair dryers, electric curlers and cigarettes.
• Ivermectin (Stromectol). This medication is taken as a single dose of two pills, with an option to take another dose in 10 days if the treatment doesn't work. Ivermectin may be used to treat lice in the pubic region or when children have pubic lice in their eyelashes. Ivermectin may not be safe for pregnant or breast-feeding women or children who weigh less than 33 pounds (15 kilograms).
• Lindane. Another prescription lotion treatment for lice contains the medication lindane. Because of its toxicity, this is usually prescribed when other treatments fail. You apply lindane to the affected area and wash it off after four minutes. Your doctor may not recommend lindane if you weigh less than 110 pounds (50 kilograms), have used it in the past few months, are a women who is pregnant or breast-feeding, or are younger than 2 years of age. Side effects may include skin irritation, seizures and, rarely, death. Using lindane in higher than recommended amounts, or for longer than recommended, increases the risk of side effects.
• Eye treatments. If public lice are found in eyelashes, they can be treated by applying petroleum jelly to the eyelid and lashes three times a day for several days. In addition, or as an alternative, the lice and nits can be manually removed from eyelashes using a tweezers. Your doctor may also prescribe an ointment, like physostigmine, which is applied twice a day for eight to 10 days. This ointment may cause annoying eye spasms and irritate the skin.

Use these medications only as directed. Applying too much can cause red, irritated skin.

Whether you use over-the-counter or prescription shampoo to kill lice, much of the treatment involves self-care steps you can take at home. These include making sure all the nits are removed and that all clothing, bedding, personal items and furniture are decontaminated. In most cases, killing lice on your body isn't difficult. The challenge is getting rid of all the nits and avoiding contact with other lice at home.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

You can get rid of pubic lice with a patient, thorough approach that involves cleaning yourself and any personal belongings that may be contaminated.

These steps may help you eliminate lice infestations:

• Use lotions and shampoos. Choose from among several over-the-counter lotions and shampoos (Nix, Rid, others) designed to kill lice. Apply the product according to instructions. Typically, you apply them and wash them off in five to 10 minutes. You may need to repeat treatment with the lotion or shampoo in seven to 10 days.
• After shampoo treatment, rinse your hair with vinegar. Grasp a lock of hair with a cloth saturated with vinegar and strip the lock downward to remove nits. Repeat until you've treated all the hair in this way. Or soak hair with vinegar and leave it on for a few minutes before combing. Then towel-dry the hair. These methods can help remove nits from the hair shaft. Cutting hair very short also can help.
• Comb wet hair. Use a fine-toothed or nit comb, fingernails or tweezers to physically remove nits from wet hair. Repeat every two to three days until all lice and nits are gone.
• Wash contaminated items. Wash bedding, clothing and towels used in the two days prior to treatment with hot, soapy water — at least 130 F (54 C) — and dry them at high heat for at least 20 minutes.
• Dry-clean or seal unwashable items. If you can't wash an item, have it dry-cleaned or place it in an airtight bag for two weeks.
• Vacuum. Give floors and furniture a good vacuuming.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

To prevent pubic lice infestation, avoid sexual contact or sharing bedding or clothing with anyone who has an infestation. If you are being treated for pubic lice, all sexual partners must also be treated.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.