Pubic Lice (Crabs)

What are pubic lice?

Pubic lice are tiny insects that live on your pubic hair (the hair around your genitals). Pubic lice are also called crabs. Lice are a type of parasite because they feed off of human blood to survive.

Pubic lice are different from the lice you may get on your head or body, so you won’t find crabs on your scalp or skin. Conversely, you won’t find head lice in your pubic area. However, pubic lice can live in other parts of your body that have coarse hair, including your:

• Armpits.
• Beard, mustache or other facial hair.
• Chest.
• Eyebrows and eyelashes (more common in children).

Crabs spread from person to person through physical contact. You can get pubic lice anytime your hair comes in contact with another person’s infested hair. Most commonly, this happens during sexual intercourse. In rare instances, you can get it by sharing personal items like towels or sheets with someone who has pubic lice.

Treatment involves applying special creams or shampoos to the affected area, which kills the lice and their eggs. You can buy over-the-counter and get prescription medications.

Are pubic lice an STD?

Pubic lice often get lumped in with sexually transmitted infections (STIs). That’s because people get pubic lice most often during sex. But pubic lice aren’t an actual disease or infection. They can also be passed in nonsexual ways.

Are pubic lice a disease?

Pubic lice don’t carry or spread diseases. So, you can’t get sick from them. But they’re annoying and itchy. You could get a bacterial infection from scratching. When you scratch, you can break your skin. Bacteria can enter your broken skin and cause an infection.

How common are pubic lice?

Pubic lice are very common. Around the world, people of every race and ethnic group have them. Pubic lice are most common in adults. Every year, about 3 million people in the United States get pubic lice.

What are the symptoms of pubic lice?

Pubic lice symptoms often show up about five days after infestation. Symptoms include:

• Pruritus (severe itching) in hairy areas, especially pubic hair.
• Irritated skin that may be bloody or red from lice bites.
• Specks of black lice droppings in your underwear.
• Small white dots on pubic hair that are hard to remove (these are lice eggs).
• Pale bluish spots on your thighs, buttocks and lower abdomen.
• Low fever and feeling run-down.

Why do pubic lice itch?

The lice feed on your blood. They make small bites on your skin. An allergic reaction to the bites causes the itchiness.

How do pubic lice spread?

You get genital crabs by coming into close physical contact with a person who has them. The lice crawl from the pubic hair of one person to another. The most common way people catch crabs is by having sex with a person who has them. However, any type of close body contact is enough to spread crabs, even if there’s no penetration or intercourse.

You can occasionally get crabs other ways, too. You can catch them by sharing or having contact with the clothes, linens and towels of a person who has them. But you won’t get crabs through casual contact, such as handshakes or hugs.

What do pubic lice look like?

Pubic lice are very small. You may be able to see crabs by looking closely at your pubic hair. Adult pubic lice resemble crabs you’d see near the ocean (that’s how they get their name). You may even see them move.

The lice look different depending on their stage of growth:

• Nits: These lice eggs are hard to see. They’re usually oval and yellow, white or pearly. Nits attach to the root of your hair (where your hair comes out of your skin). Pubic lice nits take about six to 10 days to hatch.
• Nymph: This is the young louse (singular of lice) that hatches from the egg. Each one needs about two to three weeks to become a mature adult.
• Adult: A fully grown louse has six legs. The front legs are larger and resemble a crab’s pincher claws. Adults are tan or grayish-white. They are about 1.1 to 1.6 millimeters long — about the size of the tip of a pencil. Nymphs and adult lice feed off of your blood to survive. They die within 72 hours once it falls off a person.

Can I get pubic lice from a pet?

No. Dogs, cats and other pets don’t spread pubic lice.

Are pubic lice the same as head lice?

No. The lice you can get on your head and body are a different type of lice than pubic lice. Pubic lice don’t usually attach themselves to the hair on your head.

Can children get pubic lice?

Yes. Children might get pubic lice if they sleep in the same bed or use the same towels as someone who has pubic lice. It’s more likely to infest their eyelashes or eyebrows. Pubic lice in children may be a sign of sexual abuse.

Can I get crabs by sharing a toilet seat with a person who has crabs?

You most likely won’t get crabs by sharing a toilet seat with someone who has them. The lice can’t live very long when they’re away from a human body. And their legs can’t hold onto a smooth surface like a toilet seat.

How do I know if I have pubic lice?

You may see the lice, though they’re small and can be hard to spot. That’s the best way to know for sure if you have them. Pubic lice are the size of a pinhead and look like tiny gray crabs.

How will my provider diagnose pubic lice?

You may have symptoms of pubic lice but can’t see the lice. If you’re not sure, see a healthcare provider for a diagnosis. They may use a magnifying glass or microscope to spot the lice. If you have pubic lice, your provider will likely recommend testing for sexually transmitted infections.

What kills pubic lice?

You treat pubic lice using a special shampoo or cream in the infested area. Using regular soap and hot water isn’t effective in killing pubic lice. You can typically buy shampoos and creams for pubic lice over the counter, without a prescription. They’re safe and effective. Make sure to follow the directions on the package carefully.

For the best results from the lice treatment, follow these steps:

• Check for lice in your underarm hair and other hairy parts of your body. Wash and dry your body.
• Apply the shampoo or cream on all the areas that may have crabs — thighs, underarms and trunk (lower abdomen and buttocks, including near your rectum). Don’t put it on your eyelashes.
• Leave the shampoo or cream on for the amount of time the instructions recommend, then rinse it off.
• Remove nits from hair strands using fingers, tweezers or a fine-toothed comb. Put on clean underwear and clothing after treatment.
• Clean your clothes, bed linens and towels using your washer and dryer’s hottest setting. The heat destroys the crabs. Place items you can’t wash in a sealed plastic bag for two weeks. Or take them to a dry cleaner.
• Don’t spray insecticide on your clothes or other objects in your house.
• Pause your sex life until the crabs go away, usually about two weeks.
• Repeat the treatment in nine to 10 days if the lice remain.

You should make sure everyone in your household and any sexual partners from the last two months receive treatment for pubic lice.

What are the types of shampoos and creams for pubic lice?

Pubic lice treatments that you can buy without a prescription include:

• Permethrin cream. You apply the cream to the affected area and wash it off after about 10 minutes.
• Pyrethrin with piperonyl butoxide. This is a type of shampoo you apply to the area and wash off after 10 minutes.

Common brand names of these lice treatments include A-200®, RID® and Nix®.

Are there prescription medications for pubic lice?

If over-the-counter approaches don’t work, you may need a prescription for stronger treatments. Your healthcare provider may prescribe a topical cream, shampoo or oral medication.

Oral medicine (taken by mouth) works by killing the lice once they bite you and ingest your blood. The most common oral medication is ivermectin, which you take in two doses.

Malathion is a topical cream you put on the infested area for up to 12 hours at a time.

One of the strongest prescription options is lindane shampoo (Kwell®). It destroys lice and eggs but can have serious side effects. It may be toxic to your brain and nervous system. Usually, providers recommend lindane shampoo only when other treatments have failed.

Treatment of lice and nits on eyelashes or eyebrows

You can’t use the same treatment on your eyes that you use in your pubic area. It may be possible to remove nits or lice with a comb or your fingers. However, if this doesn’t work, your provider will prescribe an ointment that’s safe to use near your eyes. This involves applying an ointment to your eyelids several times a day for up to 10 days.

Can I use other at-home treatments for pubic lice?

Special lice shampoos or creams are the only treatments that will work. They kill pubic lice. Shaving or taking hot baths won’t destroy the lice. You can use a hydrocortisone cream to stop the itching, but it won’t treat the lice.

Can I use pubic lice treatment if I’m pregnant or breastfeeding?

If you’re pregnant or breastfeeding, talk to your healthcare provider before using any lice treatment.

Should my sex partner(s) get treated for crabs?

Get in touch with your sexual partner(s) from the previous two months. They may have pubic lice, too, and will need treatment.

Does shaving get rid of crabs?

No, shaving your pubic area with a razor isn’t a treatment to get rid of crabs.

Does rubbing alcohol kill pubic lice?

You shouldn’t attempt to use rubbing alcohol to kill pubic lice. This may be effective in adult lice, but it’s not effective against nits or eggs. You should only use the medications your healthcare provider recommends.

How can I prevent genital crabs?

The only way to prevent pubic lice is to avoid any close physical contact with people who have it. Still, you can take reasonable steps to lower your risk for crabs and prevent them from coming back:

Do

• Avoid sharing personal items like clothes or towels.
• Limit your sex partners. And try to avoid sex with people who have multiple sex partners.
• Make sure your partner(s) get treated if you had pubic lice.
• Wash clothing, bedding and towels in hot water.
• Finish treatment and check that the crabs are gone before resuming sex.

Don’t

• Have sex or close physical contact with someone who has crabs.
• Share clothing, bedding or towels with a person who has crabs.
• Use insecticide sprays. They don’t control crabs and can be harmful to you.
• Try on bathing suits when shopping. If you do try them on, wear underwear.

It’s important to note that people who have other sexually transmitted infections are at higher risk for pubic lice. You should always practice safe sex by using condoms, but condoms won’t protect you from getting pubic lice.

Can I use pubic lice shampoo preventively?

Perhaps you found out that a sexual partner from the past month got pubic lice. It’s fine to use one of the lice shampoos or creams to be safe.

Will frequent showers prevent pubic lice?

Getting pubic lice has nothing to do with your hygiene. You get pubic lice by having close physical contact with a person who has them.

Are pubic lice dangerous?

No, pubic lice won’t cause serious health concerns. Usually, the main problems that the lice cause are itching and discomfort. You may get a bacterial infection if you end up scratching your skin a lot.

How long does it take to get rid of pubic lice?

Most treatments take about two weeks. If the lice don’t go away completely, you may need to repeat treatment.

Can I get pubic lice more than once?

Yes, you can get crabs again. Take steps to prevent pubic lice so you don’t get them again.

When can I resume sex?

Pause your sex life until both you and your partner(s) have finished treatment. Check that the lice haven’t returned. This could take about two weeks.

When should I see a healthcare provider?

Contact a healthcare provider if you think you have pubic lice. In most cases, over-the-counter treatment is effective in killing the lice. If this doesn’t work, your provider may need to prescribe a stronger medication.

What questions should I ask my healthcare provider?

If you have pubic lice, ask your provider:

• What pubic lice treatment do you recommend?
• How many times should I do the treatment?
• When can I resume having sex?
• Should I tell my sexual partner(s) that I have pubic lice?
• How can I prevent the lice from coming back?
• Are there any long-term complications from crabs?

A note from Cleveland Clinic

If you have pubic lice, or genital crabs, don’t feel alarmed. While crabs can be annoying and cause discomfort, it’s easy to treat them. Pubic lice won’t cause long-term health problems, either. If you’re not sure you have crabs, talk to your healthcare provider. Pubic lice treatment usually involves special creams or shampoos to kill the lice. After treatment, make sure to comb any nits (eggs) out of your hair. Wash all clothes, bedding and towels to destroy any lice living there. And advise any recent sexual partners to get treated as well.