How to Apply Pubic Lice Treatments

Pubic lice, also known as “crabs,” are tiny insects that infest the pubic hair and surrounding skin, causing intense itching and discomfort. While the thought of having them can be embarrassing, pubic lice are a common issue, and effective treatments are readily available. This comprehensive guide will walk you through everything you need to know about identifying, treating, and preventing pubic lice, ensuring you can address the problem confidently and discreetly.

Understanding Pubic Lice: The Basics

Before diving into treatment, it’s crucial to understand what pubic lice are, how they spread, and what symptoms they cause. This knowledge will empower you to confirm a diagnosis (or rule it out) and take appropriate action.

What Exactly Are Pubic Lice?

Pubic lice (Pthirus pubis) are parasitic insects that are considerably smaller than head or body lice. They are typically 1.1–1.8 mm in length, with a crab-like appearance (hence the nickname “crabs”) and six legs, which they use to cling to hair shafts. Unlike head lice, which prefer round hair shafts, pubic lice are adapted to the coarser, triangular cross-section of pubic hair. However, they can sometimes be found in other coarse body hair, such as armpit hair, chest hair, leg hair, facial hair (beard, mustache, eyelashes), and even eyebrows.

Pubic lice feed on human blood, usually every 4–5 hours. They typically live for about 30 days on a human host, during which time a female louse can lay up to 30 eggs (nits).

The Life Cycle of Pubic Lice

Understanding the life cycle is helpful for effective treatment, as different stages may be more resistant to certain interventions.

Nit (Egg): Nits are tiny, oval, yellow-white specks firmly attached to the base of hair shafts. They are about 0.8 mm long and can be difficult to see with the naked eye. Nits hatch in 6–10 days.
Nymph (Immature Louse): Once hatched, the nit becomes a nymph, an immature louse. Nymphs look like smaller versions of adult lice. They must feed on blood to survive and mature. Nymphs undergo three molts over 2–3 weeks to become adults.
Adult Louse: An adult louse is fully grown and capable of reproduction. They are about 2 mm long and have a lifespan of about 30 days. Adult lice must feed on blood to survive and will die within 1–2 days if separated from a human host.

How Do Pubic Lice Spread?

The primary mode of transmission for pubic lice is through close, sustained physical contact, most commonly sexual contact. It’s important to note that you don’t need full sexual intercourse to transmit or acquire pubic lice; close genital contact is often enough.

While less common, it is possible for pubic lice to spread through contact with infested bedding, towels, or clothing. However, since pubic lice cannot survive long away from a human body (typically 1-2 days), this form of transmission is less frequent than direct skin-to-skin contact. Petting animals does not transmit pubic lice, as these parasites are specific to humans.

Recognizing the Symptoms: What to Look For

The most common symptom of pubic lice infestation is intense itching in the affected areas, particularly at night when the lice are most active. This itching can be severe and may disrupt sleep.

Other signs and symptoms include:

Visible Lice or Nits: You might be able to see the tiny lice crawling in your pubic hair or the nits (eggs) attached to the hair shafts. Nits are often mistaken for dandruff or lint, but unlike dandruff, they cannot be easily brushed or shaken off. You might need a magnifying glass to see them clearly.
Small Blue Spots (Maculae Ceruleae): In some cases, tiny, bluish-gray spots may appear on the skin where the lice have bitten. These spots are caused by the lice’s saliva reacting with the blood.
Irritation and Inflammation: Constant scratching can lead to skin irritation, redness, and inflammation in the pubic area.
Dark Specks (Louse Feces): You might notice tiny dark specks, which are louse feces (excrement), on your skin or underwear.
Secondary Bacterial Infection: Vigorous scratching can break the skin, leading to secondary bacterial infections, characterized by increased redness, swelling, pus, or crusting.

It’s important to note that some people may not experience any symptoms, especially in the early stages of an infestation. If you suspect you have pubic lice, a thorough visual inspection is recommended.

Diagnosing Pubic Lice: Self-Examination and Medical Confirmation

Accurate diagnosis is the first step toward effective treatment. While you can often identify pubic lice yourself, a medical professional can provide confirmation and rule out other conditions.

Self-Examination: What to Look For

A self-examination can often reveal the presence of pubic lice. You will need good lighting and, ideally, a magnifying glass.

Choose a Well-Lit Area: Sit or stand in a brightly lit room. Natural light is best.
Inspect Your Pubic Hair: Carefully examine your pubic hair from root to tip. Look for:
- Adult Lice: Tiny, crab-like insects, usually grayish-white or tan, moving slowly. They are often found clinging to the hair shafts close to the skin.
- Nits (Eggs): Small, oval, yellowish-white specks firmly attached to the base of the hair shafts. They will be stuck to the hair and won’t easily slide off.
- Nymphs: Smaller versions of adult lice.
Check Other Coarse Hair: Extend your inspection to other areas with coarse hair, such as armpits, chest hair, leg hair, and even eyelashes or eyebrows if you suspect an infestation in those areas (though this is less common for initial pubic lice infestations).
Look for Bite Marks or Feces: Examine your skin for small red bumps, bluish spots, or tiny dark specks (lice feces).

If you find any of these signs, it’s highly likely you have pubic lice.

When to Seek Medical Confirmation

While self-diagnosis is often sufficient, there are times when seeking medical confirmation is advisable:

Uncertainty: If you’re unsure whether what you’re seeing are lice or nits, a doctor can provide a definitive diagnosis.
Symptoms Persist After Treatment: If your symptoms don’t improve or worsen after home treatment, a medical professional can evaluate the situation and suggest alternative approaches.
Infestation in Eyelashes/Eyebrows: Treating lice in these delicate areas requires special care and should ideally be supervised by a doctor.
Pregnant or Breastfeeding: Certain treatments may not be safe during pregnancy or breastfeeding. A doctor can recommend the safest option.
Other Medical Conditions: If you have any underlying skin conditions or are taking medications, consult your doctor before starting treatment.
Suspected Secondary Infection: If you notice signs of a bacterial infection (e.g., increased redness, pus, fever), seek medical attention promptly.
Children: If a child has pubic lice, consult a pediatrician for appropriate treatment options.

A doctor or healthcare provider can examine the affected area, confirm the presence of lice or nits, and recommend the most suitable treatment. They may use a magnifying device to get a closer look.

Comprehensive Treatment Strategies: Eliminating Pubic Lice

Treating pubic lice involves a multi-pronged approach: medicated treatments, environmental decontamination, and preventing reinfestation.

1. Medicated Treatments: The Core of Eradication

Over-the-counter (OTC) and prescription medications are the primary method for eliminating pubic lice. These products contain insecticides that kill the lice.

Over-the-Counter (OTC) Treatments

Most OTC treatments for pubic lice contain permethrin or pyrethrin. These are generally safe and effective when used as directed.

Permethrin Lotion (1%): This is a synthetic pyrethroid that kills lice and nits. It is widely available and often the first-line treatment.
- How to Use (Example):
  1. Wash the infested area with soap and water, then thoroughly dry.
  2. Apply the permethrin lotion to all affected areas (pubic hair, thighs, lower abdomen, armpits, chest hair, etc.). Ensure complete coverage, especially at the base of the hair shafts where nits are found.
  3. Leave the lotion on for 10 minutes (or as directed by the product instructions).
  4. Rinse the area thoroughly with water.
  5. Dry with a clean towel.
  6. After 9-10 days, inspect for any remaining lice or nits. A second application may be necessary if live lice are still present. This second application targets any nits that may have hatched since the first treatment.
- Example Product: Nix® Permethrin Cream Rinse (though specifically marketed for head lice, the 1% permethrin formulation can be used for pubic lice as well, following pubic lice-specific instructions).
Pyrethrins with Piperonyl Butoxide: Pyrethrins are natural insecticides derived from chrysanthemum flowers. Piperonyl butoxide enhances the effectiveness of pyrethrins.
- How to Use (Example):
  1. Apply to the affected areas, ensuring all hair is saturated.
  2. Leave on for the recommended time (usually 10 minutes).
  3. Rinse thoroughly.
  4. Comb out any remaining nits (though less critical for pubic lice than head lice, it can aid in removal).
  5. A second application may be needed 9-10 days later to kill newly hatched lice.
- Example Product: RID® Lice Killing Shampoo (again, marketed for head lice, but the pyrethrin formulation is effective for pubic lice when applied correctly).

Important Considerations for OTC Treatments:

Read Instructions Carefully: Always follow the specific instructions on the product packaging. Application times and reapplication schedules can vary.
Patch Test: If you have sensitive skin, consider doing a small patch test on a discreet area before full application to check for any allergic reactions.
Avoid Contact with Eyes: Be extremely careful to avoid getting these products in your eyes, nose, or mouth. If contact occurs, flush thoroughly with water.
Reapplication: A second treatment 9-10 days after the first is often recommended, even if you don’t see live lice. This ensures that any nits that survived the first treatment and have since hatched are eliminated.
Itching May Persist: Itching may continue for a few days after successful treatment as your body reacts to the remnants of the lice and their bites. This does not necessarily mean the treatment failed.

Prescription Treatments

If OTC treatments are ineffective or if you have specific circumstances (e.g., sensitive skin, resistance to OTC treatments, infestation in delicate areas), your doctor may prescribe stronger medications.

Malathion Lotion (0.5%): This is an organophosphate insecticide that can be used for resistant cases. It is a stronger chemical and has a distinct odor.
- How to Use: Applied to the affected area, left on for 8–12 hours, then rinsed off. May require only one application.
- Caution: Flammable. Avoid open flames or smoking while applying and until the product has dried.
Ivermectin (Oral): For severe or persistent cases, or when topical treatments are not feasible, your doctor might prescribe oral ivermectin. This medication is taken by mouth and works systemically.
- How to Use: Typically taken as two doses, 7 days apart.
- Caution: May cause side effects such as dizziness, nausea, or abdominal pain. Not recommended for pregnant or breastfeeding women.
Lindane Shampoo (1%): Historically used, lindane is now less commonly recommended due to potential neurotoxicity, especially in infants, children, the elderly, and individuals with certain skin conditions or impaired skin barrier function. It is generally reserved as a last resort if other treatments have failed.
- Caution: Should only be used under strict medical supervision and according to precise instructions.

Important Considerations for Prescription Treatments:

Follow Doctor’s Instructions: Adhere strictly to your doctor’s dosage, application, and safety instructions.
Potential Side Effects: Be aware of potential side effects and report any concerning reactions to your doctor immediately.
Drug Interactions: Inform your doctor about all medications you are currently taking, including OTC drugs and supplements, to avoid potential interactions.

2. Environmental Decontamination: Preventing Reinfestation

While pubic lice cannot survive long off a human host, taking steps to decontaminate your environment is crucial to prevent reinfestation, especially from any lice that might have fallen off.

Wash and Dry Contaminated Items:
- Clothing, Towels, Bedding: Wash all clothing, towels, bedding, and any other items that have come into contact with the infested person in the past 2-3 days.
- Water Temperature: Use hot water (at least 50°C or 122°F) for washing.
- Drying: Dry on the hottest cycle in a clothes dryer for at least 20 minutes. The high heat effectively kills lice and nits.
- Items That Cannot Be Washed: For items that cannot be machine washed (e.g., stuffed animals, delicate clothing), dry-clean them or seal them in an airtight plastic bag for two weeks. Lice and nits will die without a human host during this time.
Vacuuming:
- Carpets and Furniture: Vacuum carpets, rugs, and upholstered furniture that the infested person may have used. This helps remove any fallen lice or nits.
- Discard Bag: After vacuuming, immediately discard the vacuum cleaner bag or empty the canister into a sealed bag and dispose of it.
Do Not Fumigate: There is no need to fumigate your home. Pubic lice are not like fleas and do not infest the environment in a way that requires widespread pesticide spraying. Excessive use of pesticides indoors can be harmful to human health.

3. Special Considerations for Specific Areas

While pubic lice primarily affect the pubic area, they can sometimes spread to other parts of the body with coarse hair.

Eyelashes or Eyebrows:
- Avoid Medicated Shampoos/Lotions: Do NOT use insecticide shampoos or lotions on eyelashes or eyebrows as they can be extremely irritating and harmful to the eyes.
- Petroleum Jelly: For lice on eyelashes or eyebrows, applying a thick layer of petroleum jelly (Vaseline) twice a day for 8 days can smother the lice and nits. This method works by suffocating the lice.
- Manual Removal: Carefully remove lice and nits with tweezers or fine-toothed comb. This should be done diligently.
- Consult a Doctor: It is highly recommended to consult a doctor for lice infestations in these delicate areas to ensure safe and effective treatment.
Beards/Mustaches/Chest Hair/Armpit Hair:
- Medicated Treatments: These areas can be treated with the same permethrin or pyrethrin lotions/shampoos used for the pubic area. Follow the product instructions carefully.
- Shaving: As an alternative, shaving the affected hair completely can be an effective way to remove all lice and nits from these areas.

4. Preventing Reinfestation and Spread

Once you’ve treated an infestation, preventing reinfestation and further spread is critical.

Inform Sexual Partners: It is absolutely essential to inform all recent sexual partners (within the last month) that you have been treated for pubic lice. They also need to be treated, even if they don’t show symptoms, to prevent reinfestation for you and to stop the spread to others. This conversation might be uncomfortable, but it’s a responsible and necessary step for public health.
Avoid Sexual Contact During Treatment: Refrain from any sexual contact until you and all your sexual partners have been successfully treated and are lice-free.
Personal Hygiene: While personal hygiene does not cause or prevent pubic lice, regular washing of your body and hair can help in identifying new infestations early.
Do Not Share Items: Avoid sharing clothing, towels, bedding, or any personal items with others, especially if you know or suspect they might be infested.
Monitor for Reappearance: After successful treatment, periodically check the affected areas for any signs of new lice or nits, especially in the weeks following treatment.

Common Mistakes to Avoid During Treatment

To ensure effective treatment and prevent unnecessary complications, be aware of these common pitfalls:

Not Treating All Affected Areas: Pubic lice can spread to other coarse body hair. Ensure you treat all areas where lice or nits are present, not just the pubic area.
Not Treating Sexual Partners: This is the most common reason for reinfestation. If your partner isn’t treated, you’ll likely get re-infected.
Not Following Instructions: Deviating from the product’s instructions (e.g., leaving the treatment on for too short or too long, not reapplying as directed) can lead to treatment failure.
Over-Treating: Using too much product or applying it more frequently than recommended can irritate your skin and is not more effective.
Using Incorrect Products: Do not use head lice treatments for pubic lice if they are not specifically indicated for body/pubic lice. Conversely, do not use pubic lice treatments on the head unless specified. Never use treatments not intended for human use.
Shaving as the Only Treatment (Unless Complete): While shaving can remove lice, simply trimming may not be enough. If you choose to shave, ensure all hair is removed from the infested area to completely eliminate the lice and nits.
Neglecting Environmental Decontamination: Skipping the washing and drying of bedding and clothing can lead to reinfestation.
Panicking and Over-Cleaning: While decontamination is important, there’s no need to go to extreme lengths like discarding furniture or hiring professional exterminators. Pubic lice are not durable off the human body.

When Treatment Fails: Troubleshooting and Next Steps

If, after following all instructions diligently, you still have pubic lice, consider the following:

Incorrect Diagnosis: Could it be something else? Sometimes, skin conditions or other parasites can mimic pubic lice symptoms. Re-evaluate your diagnosis or seek professional medical confirmation.
Improper Application: Review the product instructions carefully. Did you miss any steps? Was the product applied thoroughly to all infested areas? Was the contact time sufficient?
Reinfestation from Untreated Partners: This is the most frequent cause of treatment failure. Have all your sexual partners been treated effectively?
Resistance to Treatment: While rare, some strains of lice may develop resistance to certain insecticides. If OTC treatments aren’t working, your doctor may prescribe a different medication.
New Infestation: It’s possible you were re-exposed to lice from a new source.
Residual Itching: Remember that itching can persist for a few days after successful treatment. This does not always mean the treatment failed. Look for live lice or new nits rather than just relying on the presence of itching.

If you suspect treatment failure, do not simply repeat the same treatment multiple times. Consult your doctor for further guidance. They can help identify the reason for failure and recommend an alternative course of action.

Long-Term Outlook and Psychological Impact

Successfully treating pubic lice is usually straightforward, and complications are rare. With proper treatment and prevention, you can expect a full recovery.

The psychological impact of a pubic lice infestation can be significant. Feelings of shame, embarrassment, anxiety, and disgust are common. It’s important to remember that:

It’s Common: Pubic lice are a common issue, and anyone can get them, regardless of their hygiene practices. They are not a reflection of your cleanliness or moral character.
It’s Treatable: Effective treatments are readily available, and you can get rid of them completely.
Seek Support: If you’re struggling with the emotional impact, consider talking to a trusted friend, family member, or a healthcare professional. They can offer support and reassurance.

Prioritizing your health and taking prompt action to treat the infestation is the most empowering step you can take.

Conclusion

Dealing with pubic lice can be an unsettling experience, but it’s a perfectly manageable health concern. By understanding the nature of these parasites, recognizing their symptoms, and following a clear, actionable treatment plan, you can effectively eradicate them and prevent their return. Remember to treat yourself thoroughly, decontaminate your environment, and, crucially, ensure all recent sexual partners are also treated to break the cycle of reinfestation. Empower yourself with accurate information and take decisive action; a lice-free life is easily within reach.