How to Treat Pubic Lice

Co-authored by Madeleine Flamiano | Medically reviewed by Lacy Windham, MD

Last Updated: November 10, 2022 References Approved

If you've noticed an uncomfortable itch in your genital region, you may have crabs (pubic lice). Crabs are usually sexually transmitted—in fact, there's over a 90% likelihood that you'll catch pubic lice from sexual contact with an infected person. However, pubic lice are also spread through sharing infested clothing, towels and bed linens. Here, we'll share how to deal with crabs, understand the types of medications available, and prevent future outbreaks. Read on to treat pubic lice and find relief.

Section 1 of 5:

What are pubic lice?

Pubic lice are small parasites commonly seen in the genital region. Pubic lice come in three forms: nits, nymphs, and adults. Nits are lice eggs, which look like tiny white or yellow ovals, while nymphs are immature lice that look like smaller versions of adult lice. Adult lice are tan or greyish-white and have six legs—if you view them under a microscope, their two large front legs look like pincher claws, which is why they're nicknamed "crabs."^{[1]
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Centers for Disease Control and Prevention
Main public health institute for the US, run by the Dept. of Health and Human Services
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- Nits are very hard to see, but you can find them attached to your body hair. They take 6-10 days to hatch.
- Nymphs take 2-3 weeks to fully mature into adults and reproduce.
- Both nymphs and adult lice need blood in order to survive. Nymphs and adult lice may feed up to 5 times a day.
- If they fall off you, nymphs and adult lice will die in 1-2 days.

Section 2 of 5:

How do you catch crabs?

1
People who are sexually active are most at risk of getting pubic lice. Since pubic lice prefer to live in pubic hair, these insects are spread whenever people's pubic regions come into close contact. Any sex act with an infected individual increases the likelihood of an infestation.^{[2]
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- Once people's pubic regions are close to each other, lice can easily move from one person's hairs to another individual's hairs.
- Other forms of close contact can spread pubic lice. For example, if someone kisses you, pubic lice on their eyelashes can move onto the hair on your face.
- Quick forms of contact, like a handshake, won't spread pubic lice because they aren't close and prolonged enough to expose anyone to crabs.
2
Anyone who shares items, like towels, can also contract pubic lice. If you use bedding, towels, or clothing that is infested with nits or pubic lice, then you'll come in contact with these parasites. As soon as you place the infested item against your body, the pubic lice may move to your pubic region, armpit region, eyelashes, or eyebrows.^{[3]
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- This way of spreading pubic lice is less common than sexual activity.
- Pubic lice are highly unlikely to survive on smooth surfaces, like toilet seats. They usually slip off because they can't hang onto them.^{[4]
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Section 3 of 5:

What are the symptoms of crabs?

Itchiness and inflamed skin are common symptoms of pubic lice. You'll see nits attached to your hair or lice crawling in your genital area. Pubic lice bite to feed on blood, so you'll notice itchiness as well as inflamed skin. Excessive bites from lice can lead to tiny bruises in the genital area and severe itching. You may also find small blood spots in your underwear or black spots, which are lice droppings.^{[5]
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- Sometimes, you'll have skin lesions that fill with pus from a bacterial infection. They do not, however, transmit any diseases.
- In some rare cases, you may find pubic lice in your eyebrows and eyelashes. This can cause itching, red eyes, and inflamed eyelids.
- While it's not common, pubic lice may also infect your armpit region, so you may experience itchiness and inflammation there, too.

Section 4 of 5:

Using Over-the-Counter Treatments

1
Purchase an OTC lice-killing product. Get a lotion with 1% permethrin, like one of Nix’s lice treatment products or a mousse with pyrethrins and piperonyl butoxide. Both of these OTC treatments are non-toxic to humans.
- 1% permethrin prevents lice from absorbing the sodium in blood, which they need to survive. If they can't access it, then they'll become paralyzed and die.^{[6]
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  Centers for Disease Control and Prevention
  Main public health institute for the US, run by the Dept. of Health and Human Services
  Go to source}
- When lice absorb pyrethrins and piperonyl butoxide, their nervous systems are destroyed, leading to death.^{[7]
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  Trustworthy Source
  National Pesticide Information Center
  Organization run by Oregon State University providing objective, science-based information about pests and pesticides
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2
Wash the infected area. Before you apply any treatment, make sure that your pubic region is clean and dry. Use soap and warm water to completely clean the area infested by crabs. Dry the area with a clean towel.^{[8]
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- It will be easier to thoroughly apply the treatment over the infested region when the skin is cool, clean and dry.
- Do not shave during this step, as live lice can just crawl to another area with body hair.
- Once you've dried off, immediately throw the towel into the washing machine. Use hot 140 °F (60 °C) water to kill off any nits or lice.^{[9]
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Apply your lice-killing product according to the directions. Whether you've chosen a lotion with 1% permethrin, or a mousse with pyrethrins and piperonyl butoxide, check the label. Pay attention to the recommended method for applying the treatment⁠—such as putting it on while wearing gloves⁠—as well as the correct amount of time to leave it on.^{[10]
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PubMed Central
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- When you follow the package instructions carefully, you'll get the most benefits out of the lice-killing product.
4
Leave the product on for the recommended amount of time. Shampoos may only need to be left on for about 10 minutes, but lotions and creams may need to be left on for 8-14 hours. Note the time when you apply the product and set a timer or watch the time.^{[11]
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5
Rinse off the medication and dry your pubic area. After you have left the product on for the indicated amount of time, rinse it off with warm water. Rinsing away the product will help to remove dead nits and lice from your skin. It is important to rinse the dead parasites away because they may lead to hygiene problems, like an infection, if they're left on your skin.^{[12]
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- Be sure to separate the towels you used from your other clothes and linens. Wash the towels separately to avoid cross-contamination.
- If you find nits at the base of the hair, you can just remove them using your fingernails or a fine toothed comb.
6
Use a fine-toothed comb to remove any nits. Use a "nit comb" that's specially designed to catch the tiny nits and remove them from your hair. Carefully comb through your hair, section by section. Throughout this process, dip the comb in a solution of hot, soapy water to get rid of the nits.^{[13]
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- When you're done, sterilize the comb by washing it with hot, soapy water. Rinse the pubic area to remove dead lice or nits.
- You can also use clean tweezers to carefully pluck away the nits. This will prevent them from hatching, causing another outbreak of pubic lice a few weeks later.
- After you've completed all nit-removing steps, you can shave in order to get rid of any remaining nits.^{[14]
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7
Treat lice in eyelids and eyelashes with petroleum jelly. Since you'll need a special grade of petroleum jelly that requires a prescription, consult your doctor. Let your physician know that you've seen signs of lice around your eyes. Once you receive medical-grade petroleum jelly, apply it to the edges of your eyelids 2-4 times a day over the course of 10 days.^{[15]
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- Don't use the regular lice shampoos near your eyes. Instead, use any medication your doctor prescribes or you pluck the lice using tweezers.
8
Put on clean underwear and clothing. To prevent further infestation from used clothes that may have nits or lice, put on clean clothes and underwear after your treatment. Throw the clothes you wore prior to your treatment in the washing machine. Make sure to use hot 140 °F (60 °C) water to kill any nits or lice.^{[16]
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Section 5 of 5:

Follow-Up Care and Prevention

1
Wash clothing, bedding, and towels in hot water to kill lice. Since all of the items you used since catching pubic lice may be infected, throw all of them in the washing machine. Make sure the temperature of the water is at least 140 °F (60 °C) so you can completely disinfect your load of laundry and get rid of nits or live lice.^{[17]
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- After you've washed them, put them in the dryer and select the high heat drying cycle. This cautionary measure will prevent any nits or lice from surviving.
2
Store items that can't be laundered in a sealed plastic bag for 2 weeks. If you have any garments that aren't machine-washable, like suits or delicates, put them in an airtight storage bag. Seal the bag, vacuum the air out, and place it somewhere away from any other clothes for 14 days.^{[18]
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- Keep the bag on an empty shelf, in a storage shed, or in your garage.
- 14 days is enough time for nits to hatch into nymphs—when you wait 2 weeks, both recently hatched nymphs and adult lice will die in the storage bag since they didn't have access to blood.
3
Get tested for other STIs (Sexually Transmitted Infections). Since it's common to contract other STIs when you come in contact with pubic lice, get an STI check-up at a public health clinic or with your doctor. Test for gonorrhea and chlamydia since these two STIs are commonly found in individuals infested with pubic lice.^{[19]
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PubMed Central
Journal archive from the U.S. National Institutes of Health
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- As an extra precaution, test for all the STIs you can, including syphilis and HIV.
- After you get tested, follow up with a medical professional after 3 months to check in about your sexual health status. They can also examine you to see if you're still infested with pubic lice.
4
Inform intimate partners about pubic lice and avoid sex. If you have any nits or lice remaining, you can pass pubic lice to someone else. Abstain from any sexual contact until you're certain you've eliminated all pubic lice. Inform sex partners from the last 3 months about your sexual health status and let them know you've come in contact with pubic lice. Then, encourage them to get tested.^{[20]
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- Remember that it's responsible to share your sexual health status and is a normal part of being sexually active.
5
Monitor the treated area. Watch the area over the next few weeks for signs of nits or lice. If you see more lice or experience itching and redness, follow the same process to retreat the area 9-10 days after the first treatment. Repeat all the steps for follow-up care: remove nits, launder your clothes to disinfect them, store any infested items that aren't machine-washable, and monitor the area.^{[21]
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American Academy of Family Physicians
Organization devoted to improving the health of patients, families, and communities
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- A second treatment after 9-10 days allows you to kill any live lice that just hatched before they can lay eggs.
- Some products only kill live lice, not the nits, which means you'll need to retreat the area once the nits hatch.
6
Consult your doctor if OTC treatments don't work. Ask your doctor to prescribe a stronger medication. They might recommend ivermectin as a topical therapy to combat pubic lice. If you're resistant to topical insecticides, your doctor may suggest an oral dose of ivermectin. In extremely rare cases, your doctor might direct you to use Lindane shampoo for severe infestations of pubic lice.^{[22]
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Research source} Also seek out medical attention if you experience:^{[23]
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- Severe redness due to itching
- Pus formation from a secondary bacterial infection
- Red and itchy eyes