Pubic Lice: What to Do If You Think You Have ‘Crabs’
Key takeaways:
Pubic lice are insects that attach to coarse hairs, usually pubic hair.
Insects move from person to person through close contact during sex. But it’s possible to pick up pubic lice from towels and linens.
Permethrin 1%, an over-the-counter shampoo, treats pubic lice.
Pubic lice are nicknamed “crabs” because their bodies look like tiny crabs. They’re actually insects that feed on human blood. As you can imagine (or know), pubic lice can be seriously uncomfortable. Like scabies and bed bugs, these insects cause intense itching.
Pubic lice can be embarrassing to talk about, but the good news is that they’re easy to get rid of. Let’s take a look at what you should know about pubic lice and how to get rid of them quickly.
What causes pubic lice, and how do they spread?
Lice are insects that feed on human blood. That means they only live on humans, and other animals don’t spread them. There are three types of human lice:
Body lice
Pubic lice
Pubic lice are different from the other types because they usually live on areas of the body with coarse hair, like pubic hair. Sometimes pubic lice can find their way into armpits, facial hair, and eyebrows. But they mostly stick to hair in the genital area.
Lice can’t fly or even jump. They pass from person to person by crawling, so it takes close contact for these small insects to get onto another person. In the case of pubic lice, close contact involves sexual activity. But it’s possible (though rare) to get pubic lice from sharing towels, clothing, or linen.
How common are cases of pubic lice?
There are many cases of pubic lice. Some studies show that around 2% of people have pubic lice at any given time. In the U.S. alone, that means millions of people deal with pubic lice every year.
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What are the symptoms of pubic lice?
The main symptom of pubic lice is intense itching in your groin and around your genitals. The itching can be so extreme that people end up scratching enough to get sores or skin infections like cellulitis.
Some people also notice spots of blood on their underwear, which are caused by lice bites.
Pubic lice don’t carry or transmit any diseases. So having pubic lice doesn’t put you at risk for developing any other illnesses.
What should you do if you have symptoms of lice?
If you have intense itching around your pubic hair, see a healthcare provider. They can diagnose pubic lice by finding either live lice or nits. But diagnosis can be tricky for a few reasons.
Pubic lice are smaller than other types of lice, and usually there aren’t many of them. Plus it can be hard to get a good look at your own groin. A visit to your provider can speed up the process, plus they can offer you testing for sexually transmitted infections.
If you can see the lice yourself, or you’ve had them before and recognize the symptoms, you can start treatment without seeing a healthcare provider.
How do you treat pubic lice?
Pubic lice will not go away on their own, so you do need treatment. But pubic lice are easy to get rid of with over-the-counter shampoos or creams that contain:
Permethrin 1% (like Nix)
Pyrethrins 0.33%/piperonyl butoxide 4% (like Rid)
Once you’ve purchased your treatment of choice, here’s what to do next:
Read the instructions that came with your treatment.
Wash the area(s) where you have pubic lice and thoroughly towel dry.
Apply the lotion or shampoo. Make sure to completely drench your pubic hair and leave it on for the entire time the instructions recommended.
Remove the treatment according to the instructions.
At this point, all the adult lice will be dead. But you’re not done just yet:
Use a nit comb and carefully comb through all the hair. This will remove the unhatched eggs. You can buy a nit comb at a local drugstore or online.
Put on clean underwear.
Gather any clothing, towels, and bedding that you’ve recently used and wash them in hot water (at least 130°F). Then dry on high heat. If any of these items can’t go in the machine, store them in a sealed plastic bag for 2 weeks.
You don’t need to spray anything in your house. The lice will die on their own if they can’t live on your skin.
For the next 2 weeks:
Continue to wash items in hot water and dry on high heat.
Don’t share any clothing, bedding, or towels with anyone.
Avoid sexual activity.
At the end of 2 weeks, check and see if you have any new lice (or symptoms). If you do, you’ll need to repeat the treatment steps. Most people need a second course of treatment before all the lice are gone. You might need to use a prescription-strength treatment the second time, so it’s a good idea to talk to your healthcare provider.
It’s also helpful to let your sexual partner(s) know that you’re treating pubic lice. They should also get checked and start treatment.
The bottom line
Pubic lice are an insect that live in pubic hair and feed on human blood. Pubic lice don’t transmit any diseases. But they do cause intense itching, which is very uncomfortable and bothersome. People usually get exposed to pubic lice from sex. The good news is that it’s easy to get rid of pubic lice with over-the-counter medications.
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References
Centers for Disease Control and Prevention. (2019). Parasites.
Dholakia, S., et al. (2014). Pubic lice: An endangered species?.
Centers for Disease Control and Prevention. (2019). Parasites— Lice.
Kalter, D. C., et al (1987). Treatment of pediculosis pubis. Clinical comparison of efficacy and tolerance of 1% lindane shampoo vs 1% permethrin creme rinse. Archives of Dermatology.
National Health Service. (2022). Pubic Lice.
