STD - Pubic Lice

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DEFINITION

• 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
   • "Answers to your questions about teen sexual health and sexually transmitted diseases"
   • http://www.iwannaknow.org
2. Sexually Transmitted Diseases Treatment Guidelines 2002. MMWR. 2002; 51(RR-6):1-80
3. Public Health Agency of Canada.
   • Sexually Transmitted Infections (STI), Sexual Health Facts and Information
   • http://www.phac-aspc.gc.ca/std-mts/faq_e.html

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

HOME CARE ADVICE FOR PUBIC LICE PENDING TALKING WITH YOUR DOCTOR

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: http://www.ashastd.org  
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.