Pubic lice (crabs)
Pubic lice are insects that live in coarse body hair, mainly in the pubic area. They spread through close body contact, almost always sexual, and cause itching.
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Medicines commonly prescribed for Pubic lice (crabs)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CREAM, 5 g permethrin / 100 gActive substance: permethrinManufacturer: Galenicum Derma S.L.U.Prescription requiredDosage form: CREAM, 5 g permethrin / 100 gActive substance: permethrinManufacturer: Unipharma S.A.Prescription required
Pubic lice are insects that live in coarse body hair, mainly in the pubic area. They spread through close body contact, almost always sexual, and cause itching. They do not transmit disease and are easy to eliminate, but finding them has one important practical consequence: anyone with pubic lice has had intimate contact carrying risk, so it is worth taking the opportunity to screen for other sexually transmitted infections.
How they present
- itching in the pubic area, usually worse at night, starting one to three weeks after infestation;
- small bluish or grey marks on the skin of the lower abdomen and thighs, lasting several days;
- dark spots in the underwear: these are the insects' droppings;
- blood spots from scratching;
- nits: oval, whitish eggs firmly glued to the base of the hair;
- the insect itself: 1–2 mm, greyish-yellow, broad and crab-like, gripping the hair;
- scratches and crusts from scratching, sometimes becoming infected.
Where they occur
Not only in the pubic area: they live in any coarse hair.
- pubic area and groin;
- abdomen and thighs;
- chest and armpits;
- beard and moustache;
- eyebrows and eyelashes: in a child this location calls for careful assessment, because it can indicate inappropriate contact, though it is also transmitted through close living and bedding;
- they do not live on the scalp: the louse there is a different species.
How they spread
- sexual and close body contact: the main route;
- condoms do not protect, because the contact is skin to skin;
- shared bedding, towels and clothing, less commonly;
- away from the body they survive one to two days;
- they do not spread through toilet seats or swimming pools;
- they do not come from animals.
When to see a doctor
- you have persistent itching in the genital area;
- you have seen insects or nits;
- there are scratches with pus, extensive redness or swollen nodes in the groin;
- treatment has not worked;
- the eyelashes are involved;
- you are pregnant or breastfeeding: the product must be chosen carefully;
- it is a child;
- you want screening for other sexually transmitted infections — which is recommended in all cases.
Treatment
- 1% permethrin cream or lotion: applied to the affected area, left for the stated time and rinsed off;
- other options: malathion, or oral ivermectin for resistant cases;
- repeat after 7–9 days: essential, because the eggs survive the first treatment;
- treat all areas with coarse hair — groin, abdomen, thighs, chest, armpits, beard — not just the pubic area: this is the commonest mistake and the reason they "come back";
- treat all sexual partners from the previous three months, whether or not they have symptoms;
- remove the nits with a fine comb or tweezers after treatment;
- on the eyelashes: these products are not applied there. Thick petroleum jelly is used twice a day for 8–10 days and the nits are removed with tweezers, always under medical direction;
- antihistamines and a mild steroid for residual itching;
- antibiotics if the scratches have become infected.
Shaving is not necessary: it does not remove pubic lice, because the nits stay glued to the base of the hair, and it irritates already inflamed skin.
Clothing and the home
- wash clothing, towels and bedding used in the previous three days at 60 °C and dry hot;
- anything that cannot be washed goes in a sealed bag for seven days;
- vacuum the mattress and upholstery;
- there is no need to fumigate or use household insecticides.
The screening worth doing
This is the most useful part of the whole process. When pubic lice are found, testing for chlamydia, gonorrhoea, syphilis, HIV and hepatitis B and C is recommended, because they share a route of transmission and are frequently symptomless. Pubic lice are unpleasant; finding a silent chlamydia infection in time can prevent far greater consequences.
Common questions
Are they the same as head lice? No: they are different species and they do not swap locations.
Can you catch them from public toilets? It is very unlikely. Transmission requires close body contact.
Can I have them without having had sex? It is possible through shared bedding or towels, though uncommon.
Does the itching continue after treatment? It can last a week or two as a skin reaction. Do not repeat the treatment on your own initiative if you see no live insects.
Do I need to tell my partner? Yes, because they need treating even without symptoms; otherwise you will reinfect each other.
Online consultation
In an online consultation the doctor confirms the diagnosis from photographs, chooses treatment appropriate to your situation — pregnancy, breastfeeding, age — explains every area that needs treating and the second course, and advises which sexually transmitted infection screening to have.
This material is for information only and does not replace a medical consultation.
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Reviewed on Jul 16, 2026
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