Pubic lice

The skin around pubic lice bites can be very itchy, especially at night. The itchiness is caused by a reaction with the lice’s saliva. Some people also feel itchy on the rest of their body.

The bite marks can be seen as blueish-gray or red, sometimes slightly raised patches on the skin.

They can scab over if scratched open. They can become inflamed and fester if bacteria get in. The lymph nodes in the groin area sometimes swell up as well.

Pubic lice are parasites that only affect humans, just as head or body lice do. Pubic lice mainly live in the pubic hair, hence their name. But they can also live in armpit hair, thick chest and body hair, beard hair, and more rarely in the eyebrows or eyelashes.

The lice bite into the skin to get to the blood. They don’t have any other sources of food. That is why pubic lice can only survive for 1 to 2 days if they fall off a human body.

Female pubic lice live on the human body for around 3 to 4 weeks, and lay about 30 eggs during that time. Lice eggs are also called nits. Pubic lice lay them in the hair, normally close to the hairline. After 6 to 10 days the nits hatch into immature pubic lice, called nymphs. They are sexually mature after ten days and then reproduce.

Pubic lice cannot fly or jump. So, close body contact is needed for them to be passed on from one person to another. They are mainly passed on during sex, and in rare cases through bedding or shared towels.

Like head lice, pubic lice can also be passed on despite good physical hygiene.

Rough estimates suggest that about 2% of the global population have pubic lice. Overall, pubic lice are less common than head lice. It seems that there are fewer people now have pubic lice because more people shave or otherwise remove their pubic hair. There are no exact statistics on the number of people with pubic lice for Germany.

Some parasites can hook onto your own hair, especially in the genital area, during sex or close body contact with a person who has pubic lice. People often don't notice that they have lice at first. The pubic lice reproduce within a few weeks and the first symptoms develop and become more severe.

Festering inflammations, such as impetigo, can develop if bacteria enter the bites or scratched open skin. The eyelids can become inflamed, swollen, and crust over if the eyebrows and eyelashes are infested for a longer time. The eye itself might become reddened if the conjunctiva is infested.

There are no other complications from pubic lice, unlike other types of lice: For instance, body lice in particular can pass on certain germs that can cause severe infectious diseases like typhus.

The signs of pubic lice include itching and blueish-gray or red patches of skin in the genital area or armpits. Finding living pubic lice or their milky, shiny eggs (nits) when looking more closely confirms that suspicion. Pubic lice droppings can sometimes also be seen as rust-brown crumbs.

The whitish-gray pubic lice are about 1 to 2 millimeters in size. They can be seen with the naked eye. But doctors sometimes also use a magnifying glass or examine hair samples under a microscope. They can easily be told apart from other types of lice due to their crab-like body that is wider than it is long.

The risk of getting pubic lice increases the more different sexual partners you have. That also increases the risk of other sexually transmitted infections. Nearly one third of people who are diagnosed with pubic lice are also diagnosed with another sexually transmitted infection. That is why doctors often check to see if there are any other infections, such as chlamydia, HIV, syphilis, or a gonococcal (gonorrhea) infection.

Pubic lice may be a sign of sexual abuse in children – but they are not proof.

People who shave or otherwise remove their pubic hair have a lower risk of pubic lice. But there are no reliable preventive measures. Condoms do not protect against these parasites either.

If you are diagnosed with pubic lice, the most important thing is to make sure you don't pass them on to other people. That means not having sex until you are sure that treatment has completely gotten rid of the pubic lice.

It is also important to tell everyone you had sex with in the three months before the diagnosis about the pubic lice. They can then examine themselves and get treatment if necessary, so that they don't pass the pubic lice on either.

You should wash textiles at 60 degrees Celsius (140 degrees Fahrenheit) to not pass pubic lice on through bedding, towels, or clothing and to avoid getting pubic lice again yourself after treatment. If that isn’t possible, you should seal them in a plastic bag and not use them for two weeks.

Topical lotions are a common and easy-to-use option. They contain the active ingredients permethrin or pyrethrin. You soak the affected areas, leave the lotion to take effect for ten minutes, and then rinse it off with water. The dead pubic lice are then washed away.

To make sure the nits are also removed, it is important to carefully comb out the pubic hair with a fine nit comb which is usually included.

People who want to make the therapy more effective can also shave the affected areas beforehand.

To make sure that all pubic lice have been dealt with, you can repeat the treatment after 7 to 10 days. Ivermectin is an option if the pubic lice do not go away. It is available as a lotion or in tablet form.

If you have a pubic lice infection, it is important to seek medical advice, for instance from a dermatologist or sexual health expert, and to decide on a treatment together with them. Medical assistance is especially advisable if your eyelashes are affected.

When people are ill or need medical advice, they usually go to see their family doctor first. In our "Health care in Germany" topic you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.