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STD - pubic lice

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Pubic Louse
Pubic Louse

Pubic Lice
Pubic Lice

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

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
  2. Sexually Transmitted Diseases Treatment Guidelines 2002. MMWR. 2002; 51(RR-6):1-80
  3. Public Health Agency of Canada.

If not, see these topics
  • 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, a sexually transmitted disease
  • Questions about PUBIC LICE, a sexually transmitted disease
  • Questions about TRICHOMONAS, a sexually transmitted disease

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

  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:
  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.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 4/2/2009

Content Set: Adult HouseCalls Online

Portions Copyright 2000-2009 Self Care Decisions LLC; Copyright LMS, Inc.

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