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STI - Pubic Lice

Is this your symptom?

  • Pubic lice, a sexually transmitted disease (STD)

Some Basics...

  • Pubic lice are tiny wingless insects that live only on human beings. They are also called "crabs."
  • Pubic lice are very easy to spread to others. They are mainly spread through skin-to-skin contact during sex. If you have pubic lice, there is a 95% chance of spreading them during sex. It is possible that they can be spread through things like infected bed linens or toilet seats. But this is very rare.
  • Pubic lice are annoying but cause no serious health problems.
  • Up to 30% of people with pubic lice also have another sexually transmitted infection (STI).


  • Itching of the pubic area is the main symptom.
  • Pubic hair has gray bugs (lice) 1/16-inch (2 mm) long. They move quickly and are hard to see.
  • Nits (white or tan eggs) stuck to hair shafts near the skin. Unlike dandruff or sand, nits can't be shaken off the hair shafts.

When to Call for STI - Pubic Lice

Call Doctor or Seek Care Now

  • You feel weak or very sick

Call Doctor Within 24 Hours

  • Pubic area looks infected (pus, soft scabs, or open sores)
  • Moving lice in pubic hair and it has been more than 6 hours since treatment
  • Pubic lice or nits come back within 1 month
  • Yellow, green, or gray vaginal discharge
  • White or yellow discharge from penis
  • You think you need to be seen

Call Doctor During Office Hours

  • Pubic lice
  • You have other questions or concerns

Care Advice

Pubic Lice

  1. What You Should Know:
    • Pubic lice are tiny wingless insects that live only on human beings. They are also called "crabs."
    • Pubic lice are annoying but cause no serious health problems.
    • Pubic lice are spread easily. They are spread by skin-to-skin contact during sex. They cannot jump.
    • You can treat pubic lice at home.
    • Here is some care advice that should help.
  2. Treatment - Shampoo Area with Nix: Buy Nix anti-lice creme rinse (permethrin). Follow these instructions:
    • Pour about 2 ounces (60 mL) of the cream onto washed and towel-dried pubic hair. Add a little warm water to work up a lather. Be sure to work the cream into all the hair down to the roots.
    • Leave the Nix on for a full 20 minutes (10 minutes is not long enough to kill all the lice).
    • Rinse the hair and dry it with a towel.
    • Use Nix again in 1 week to kill any nits that were missed.
    • Read all package instructions.
  3. Treatment - Using Other Lice Shampoos:
    • There are other over-the-counter lice shampoos made using pyrethrin. Examples include A-200 Clear, R&C, Pronto, and RID.
    • If this type of shampoo is used, it must be put on dry hair.
    • You should repeat the treatment in 7 days to kill and nits that were missed.
    • Read all package instructions.
  4. Pregnancy and Breastfeeding: The CDC says that women who are pregnant or breastfeeding can be treated with permethrin products (Nix).
  5. Sexual Contacts:
    • Sexual partners that you have had during the last month also need treatment. They still need to be treated even if they don't see any lice.
    • Do not have sex until 2 weeks after treatment. All lice and nits should be gone before you have sex again.
  6. What to Expect:
    • With 2 treatments, all lice and nits should be killed.
    • If they come back, this can mean a few things. It most often means you have had another contact with an infected person. It can also mean the treatment was not left on long enough or repeated.
    • Even after treatment, itching may last for 1 to 2 weeks.
    • There are no lasting problems from having lice. They do not carry other diseases.
  7. Pregnancy Test, When in Doubt:
    • If there is a chance that you might be pregnant, use a urine pregnancy test.
    • You can buy a pregnancy test at the drugstore.
    • It works best first thing in the morning.
    • Follow all package instructions.
  8. Call Your Doctor If:
    • Pregnancy test is positive or you have trouble with the at-home test
    • Moving lice in pubic hair and it has been more than 6 hours since treatment
    • Pubic lice or nits come back within 1 month
    • You think you need to be seen
    • You get worse

How to Remove Dead Lice and Nits

  1. What You Should Know:
    • Only live lice can transmit lice to another person. Nits (lice eggs) do not transmit lice.
    • Most nits (lice eggs) are dead after the first treatment with Nix. The others will be killed with the 2nd treatment in 9 days.
    • Removing the dead nits is not essential. However, it may help with the anti-lice treatment and most people just find the notion of having nits in their hair unpleasant.
  2. Instructions:
    • Remove the dead nits and lice by combing with a special nit comb or pull them out one by one.
    • Repeat this every 2 to 3 days for 3 weeks, until you are sure all of the lice and nits are gone.
    • Wetting the hair with water makes removal easier.
    • Do not use any products that claim they loosen the nits. Here is the reason: they can interfere with the ability of Nix to stay on the hair and keep working.

Hotlines and Internet Resources

  1. STI Resource:
    • American Sexual Health Association provides information on STIs, such as chlamydia, gonorrhea, HPV/genital warts, herpes, and HIV/AIDS. It can provide referrals to local clinics.
    • Their website is at: American Sexual Health Association.
  2. Internet Resources:
    • American Sexual Health Association: This website has answers to your questions about sexual health and STIs. It can be found at I Wanna Know.

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 5/23/2019 1:00:25 AM
Last Updated: 3/14/2019 1:00:28 AM

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