Crabs and nit-picking

Originally Published: September 13, 1996 - Last Updated / Reviewed On: March 16, 2009
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Dear Alice,

I think I have pubic lice, a.k.a. "crabs." Do I need to see a doctor about this problem, or is there over-the-counter medication of some kind I can use to expel the little buggers from their new home? Also, I'm curious as to how I got them since I haven't had sex for several months and this is a recent development. Can one contract this problem from sharing clothing, towels, or bedclothes?

Thanks Alice,
Itching to Know

Dear Itching to Know,

Itching is never a comfortable situation. Lice eggs (nits) are small, gray, teardrop-shaped eggs that fasten themselves onto individual hairs. The crabs actually look like mini-crabs, and cause intense itching. Effective, over-the-counter treatments for pubic lice are available at drugstores even though they are used primarily for head lice (read the label for products gentle enough to use on pubic hair and genitals). Look for medications that are 1 percent permethrin creme rinses since they're milder than prescription medications. Shampoo the product into pubic and surrounding body hair and skin as directed. For men, avoid applying the treatment to the tip of the penis. For women, avoid contact with the exposed mucous membranes of the vulva. Another application, after seven to ten days, may be necessary.

Pubic lice are most commonly spread through sexual contact. However, lice can also be transmitted by direct nonsexual contact with someone who has them, or with that person's clothing, bedding, furniture, and other personal belongings. Although you have not had sex during the past several months, any close body contact, whether or not it involved any kind of sexual activity, with someone who has lice could have given you pubic lice. Pubic lice are not limited to pubic hair — they can also be found on other hairy parts of the body. If you have been living with someone or know someone who has pubic lice (whether or not you are aware of her/his condition), you may have been the unlucky recipient of pubic lice via contact with an infested individual's personal belongings.

To help stop the spread of pubic lice and eggs, wash affected clothes and bedding in water that is at least 140 degrees Fahrenheit (60 degrees Celsius... the hot water cycle), or put them in a sealed plastic bag for two weeks. Sexual partners, roommates, and family members who have been exposed need to take the same treatment steps.

If the itching continues to be a nuisance after treatment has been completed, something else may be "bugging" you down there. Skin in and around the genital region is generally more sensitive than skin of more exposed areas, such as the arms and legs. You may be experiencing an allergic reaction to lotions, creams, perfumes, or soaps. Try using a different lotion, cream, or soap, preferably ones without perfumes and dyes, since these are better for sensitive skin. Remember that you may need to try several different brands until you find the one that is right for you.

Another possible cause of the itching could be dry skin. Since pubic lice are very small in size (up to two millimeters), it's possible to mistake small skin flakes for pubic lice. In this case, use an emollient, sensitive skin formula lotion or cream after you shower and before you go to bed until the skin is no longer dry, scaly, and itchy. Also, try a moisturizing cleansing bar rather than soap, and warm rather than hot water, both of which will be less drying to your skin.

If none of these recommendations works well, you may want to see a health care provider so that s/he can examine you and determine appropriate treatment(s). For students at Columbia, you can make an appointment by calling x4-2284 or logging into Open Communicator.

For more information on what to do to help you regain peace of mind (and body) you can also review the related questions below. All the best you and good luck letting these annoying little critters know that they should bug off!

Alice