Pubic lice

Pubic lice pass from person to person through close skin contact. The parasites can infest any hirsute area of the body, but mainly the genital area. Their bites cause bad itching. Pubic lice can be treated successfully with anti-lice products.

At a glance

  • Pubic lice are mainly transmitted through sexual contact.
  • The parasites feed on human blood which they suck from hirsute areas of the skin.
  • Bites from pubic lice cause itching in the intimate area, but also in the armpits and other hirsute parts of the body where the lice have nested.
  • They are diagnosed by the doctor finding the lice and nits in the hair. The naked eye is usually enough to see them.
  • There are special solutions and creams for killing off pubic lice. Bedding and clothes should be washed with a hot wash.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

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What are pubic lice?

Pubic lice – also known as crab lice or crabs – are parasites that nest in hirsute areas of the skin, mainly in the genital area. However, they can also affect other regions such as the armpits, breasts, beards or, in rare cases, eyebrows and eyelashes.

Pubic lice are normally transmitted via intimate contact. They are therefore classified as a sexually transmitted infection (STI). More rarely, they are passed on via clothing, bedding, or towels.

When the lice come into contact with hirsute skin, they lay their eggs there and suck blood. Anti-lice solutions or creams are an effective treatment.

What are sexually transmitted infections (STIs)?

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What are the symptoms of pubic lice?

Three things indicate that pubic lice have nested:

  • (severe) itching
  • bluish-gray or red bite marks
  • scratched, sometimes scabby patches
The symptoms of pubic lice include itching, bite marks and scratched spots.

The itching is caused by the saliva that the lice excrete when they bite to prevent the blood from coagulating. The itching can be worse at night.

Severe scratching leaves typical marks on the skin. The scratched areas of the skin can cause skin infections. The lymph nodes near to the scratched areas, for example the groin, sometimes swell up, too.

How are pubic lice transmitted?

Pubic lice are passed on through close body contact, mainly through sexual contact with an infected person. They can also be transmitted if someone shares bedding or clothes with someone who has pubic lice.

The risk of infection also increases if sexual partners are changed frequently.

How common are pubic lice?

It is roughly estimated that around 2 percent of the world’s population have pubic lice but it is not known how common it is in Germany. Infection rates have fallen substantially over recent years. This is attributed to the fact that intimate shaving is increasingly common.

How can pubic lice be prevented?

If pubic lice have been detected, it is particularly important not to pass them on to other people. This means not having any sexual contact until you are sure that you have successfully got rid of the pubic lice with treatment.

It is important to inform anyone with whom you have had sexual contact in the last three months prior to the diagnosis about the pubic lice infestation. This way they can also be examined and treated, if necessary.

If someone in your household has pubic lice, things like clothing, towels and bedding should be washed on a hot wash at a minimum temperature of 60 degrees before being used by others.

Apparently shaving the intimate area and the armpit hair makes it difficult for the parasites to nest there. But shaving does not provide reliable protection.

Important: Condoms do not protect against infection, because skin-to-skin contact is enough to get infected.

How are pubic lice diagnosed?

They are diagnosed by the doctor finding the lice and eggs (nits) on the hair shaft. This can be done with the naked eye, but it is easier with a magnifying glass or microscope, as the lice are only about one or two millimeters in size.

If pubic lice are suspected, the eyelashes, eyebrows and any other hirsute areas of the body should be examined for the parasites, too.

How can one get rid of pubic lice?

A pubic lice infection can be easily treated with anti-lice products. The aim is to get rid of the lice and their eggs. If you want to help the treatment, you can shave the affected areas of the body beforehand. It is important to then carefully dispose of the cut hair.

Pubic lice are easily treated with de-lousing products and simple hygiene measures.

Local treatment

Local treatment is administered using special solutions or creams. Products like these usually contain agents such as permethrin and pyrethrin. These two substances are also used to treat head lice but only pyrethrin is also approved for treating pubic lice.

You normally apply the products to the affected areas, leave them a few minutes to take affect according to the instructions for use and then wash them off with water. After treatment, nits and lice should be combed out using a special comb (nit comb), and fresh clothing should be put on.

The products are well-tolerated but the permethrin solution in particular should only be used after consulting a doctor, especially during pregnancy or in the case of small children.

If the itching continues about a week after the first treatment, or if lice or eggs are still being found, the treatment should be repeated. If the pubic lice do not go away, the product ivermectin is also an option. This can be applied externally or taken as a tablet. This treatment is not recommended for pregnant women with crabs (pubic lice).

Important: If eyelashes and eyebrows are affected, you can suffocate lice by putting a greasy ointment like Vaseline on them. The doctor can then carefully remove nests and lice with tweezers. To prevent injury, it is advisable not to use sharp implements around the eyes yourself. The eyebrows can be shaved, too.

Treatment for sexual partners

Committed sexual partners should also be treated with anti-lice products and close body contact should be avoided until the treatment has finished.

People living in the same household as anyone infected, but who have had no sexual contact with them and who have no symptoms do not need to be treated.

Hygiene measures

Bedding, towels and clothes need to be machine-washed at a minimum of 60 degrees. If this is not possible, you should keep them sealed in a plastic bag for two weeks and not use them.

There is no need to disinfect smooth surfaces or objects such as toilet seats that the lice cannot cling to, or even whole rooms.


In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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