The Facts About Pubic Lice

Pubic lice, colloquially known as crabs, affect about 3 million people in the United States each year. Find out what you need to know about these pesky parasitic insects that would love to make a home in your pubic hair.

Pubic lice are tiny parasitic insects that can be found in an affected individual's genital area. A single louse typically measures in at 1/16 of an inch or less, according to Mayo Clinic. They earned the nickname crabs because of the resemblance in their body shapes.

If you have pubic lice, it doesn't necessarily mean you are unclean or unhygienic. More than likely, it's because you came into close contact with them. Pubic lice attach themselves to coarse body hair using their front legs to hold on tight.

Though most commonly found in the genital area, pubic lice can also make a home on your chest, back, armpit, leg or facial hair. Pubic lice are different from head lice, which only live in scalp hair.

Pubic lice subsist by biting and drinking the blood of their host, and the bites can lead to intense itching. The intensity of the itching is caused by the body's allergic reaction to the saliva of the pubic lice, which makes contact with the body as the parasites feed on your blood.

You may have crabs if you experience persistent and intense itching in any of the following regions that are covered with coarse hair:

• Armpits
• Back
• Chest
• Face
• Eyebrows or eyelashes (more common in children than adults)
• Genital area (the most common)
• Legs

Other signs that you may have pubic lice include the presence of a black powder-like substance on your skin or your clothes. This substance is, in fact, the poop of the pubic lice.

You may also notice small white or grayish eggs and/or very small, slowly moving insects in your pubic hair.

If you have been scratching the affected area, there may be inflammation, bleeding or scabs.

Pubic lice are spread primarily through sexual activity or, more generally, through close sexual contact.

However, you don't necessarily have to have sex to get a pubic lice infestation. This is because pubic lice can linger on linens, blankets, clothes or towels after an affected person has used them. Unaffected individuals who come into contact with these infested materials can catch pubic lice.

If you're concerned about having pubic lice, make an appointment with your doctor. Testing for pubic lice is pretty straightforward.

Your doctor can confirm whether or not you have pubic lice by conducting a visual inspection. If the doctor sees moving lice in your pubic hair (or other coarse body hair), they can confirm that you have crabs and move on to recommending treatment options.

Anyone can get pubic lice. In fact, crabs consistently affect 2 percent to 10 percent of the world's population. On average, about 3 million people in the U.S. get infected with pubic lice each year.

Every gender, race and sex is represented in that number pretty evenly. That being said, certain groups of individuals are at greater risk for pubic lice, including men who have sex with men, individuals who have sexually transmitted infections (STIs) and those who have multiple sexual partners.

Particularly severe or untreated pubic lice infestations can lead to complications.

Primarily, pubic lice can lead to repetitive and frequent scratching due to the intense itching. In some cases, this may cause the skin to break and lead to secondary infections.

Another complication that can occur is a change in skin color. Patches of skin that pubic lice have fed on the most or for extended periods of time may turn a pale blue color.

Children who have pubic lice on their eyelashes—a common sign of sexual abuse—may develop conjunctivitis, which is considered to be a form of pink eye.

Finding out you have pubic lice can lead to feelings of panic, disgust, discomfort and even shame. But the truth is, there is no need for any of those feelings. Millions of people in the U.S. come into contact with pubic lice and that's completely independent of their cleanliness or worth as a person.

Fortunately, any feelings you may have are often shortlived because there are over-the-counter (OTC) and other treatments available that can effectively rid you of those pesky parasites in a short time.

Pubic lice can be treated with OTC topical lotions or shampoos whose key ingredient is 1 percent permethrin (Nix) or pyrethrin, which can kill pubic lice. If, for whatever reason, these options aren't effective, your doctor can prescribe one of the following stronger treatments, according to Mayo Clinic:

• Ivermectin (Stromectol), an oral medication
• Malathion, a prescription lotion

If the eyelashes or eyebrows are infested with crabs, your doctor may recommend you carefully apply petroleum jelly nightly to your eyelashes and eyebrows and remove it when you wake up the next day. This can take up to several weeks to fully get rid of the lice.

You should note that when you are treating for pubic lice, simply shaving the affected area won't rid you of the infestation. Furthermore, you should inspect and treat all hairy areas of the body even if they're not currently infested, because lice commonly migrate from one area of the body to another to avoid treatment.

Though they're not recommended as a first line of defense for pubic lice, if you want to avoid medication or don't have the means to obtain it, there are natural ways to treat pubic lice at home.

Some at-home treatments for pubic lice include:

• Anise oil, olive oil or coconut oil (to coat and suffocate the lice)
• Lemon juice, witch hazel or apple cider vinegar
• Petroleum jelly (useful for sensitive areas, including eyebrows)

Be aware that at-home treatments require extra diligence and care and may increase the risk of community spread.

Once you have treated the affected areas of your body and done a thorough inspection to ensure that you are completely rid of pubic lice, the next step is to wash anything that has come into contact with your body in hot water. This would include towels, sheets, blankets and clothes, and anything they have contacted. For anything not washer-friendly, put them in an air-tight bag for two weeks to ensure any stragglers are killed. Better still, send your infected garments to the dry cleaner.

Moving forward, be sure to let all of your sexual partners know about your infestation so they can check and treat themselves. Though protected sex is always a good idea, it doesn't stop you from coming into close contact with pubic hair during sex. You could unknowingly come into contact with an infested patch of hair at any time.

The best means of prevention is to treat yourself, let your sexual partners know, disinfect any materials that may be infested and try to ensure that your future sexual partners are crab-free before engaging in sexual activity.

How do you know if you have pubic lice?

You can determine if you have pubic lice by visually inspecting the area in question. If you see small moving insects or white or grayish eggs on your pubic hair and are experiencing intense itching in that area, then you likely have pubic lice. You should talk to your doctor to confirm this and discuss treatment options.

How serious are pubic lice?

Pubic lice are annoying and uncomfortable but easily treatable. However, complications can arise from severe or untreated infestations. Over time, you may develop skin discoloration, eye infection (if your eyelashes are affected) or secondary infections. Treatment is fairly simple once a diagnosis has been confirmed, and over-the-counter medications can help to quickly deal with the infestation.

Are pubic lice harmful?

Pubic lice are harmful in the sense that they are parasitic and can lead to extreme discomfort. They can lead to secondary infections if you ignore them. If you think you may have pubic lice, talk to your healthcare provider and seek treatment right away to avoid potential complications and future spread. If you have crabs, you should also tell your partner(s) so they can make sure they are not infested.