The pubic or crab louse (Phthirus pubis) is a parasitic insect that spends its entire life on human hair and feeds exclusively on blood, four to five times daily. Humans are the only known host of this parasite. Pubic lice usually infect a new host only by close contact between individuals, such as when there is sexual contact among adults. Parent to child infestations are more likely to occur through routes of shared towels, clothing, beds or closets. Adults are more frequently infested than children.
The life-cycle from egg to adult is 22 to 27 days. The egg hatches, producing the first nymphal stage, after which three moltings develop to nymph 2, nymph 3 and subsequently to either a male or female louse. The incubation period of the egg lasts seven to eight days, while the rest of the cycle is taken up with the development of nymphal stages. The average adult female lives for 17 days and the male 22 days.
Symptoms of Pubic Lice Infestation
The main symptom is itching, usually in the pubic hair area. It results from hypersensitivity to louse saliva, and it becomes strong enough two or more weeks following initial infestation. In the majority of infestations, a characteristic gray-blue or slate coloration appears (maculae caeruleae) at the feeding site, that may last for days and is also characteristic of the infestation. Pubic lice are primarily spread through sweat and body contact or sexual contact.
Although any part of the body may be colonized, crab lice favor the hairs of the genital and peri-anal region. Especially in male patients, pubic lice and eggs can also be found in hair on the abdomen and under the armpits as well as on the beard and mustache, while in children they're usually found in eyelashes. Infestation with pubic lice is called Phthiriasis or Pediculosis pubis, while infestation of eye-lashes with pubic lice is called Phthriasis palpebrarum.
Treatment of Pubic Lice Infestation
Precautionary Treatments
- Know the Difference: Since body lice lay eggs in your underwear and will hide in certain parts of your body (including your genitals), it's important to know the difference between body lice and pubic lice, and to identify pubic lice as the problem before treating yourself.
Go sit on a toilet or in a well-lit area and spread your pubic hair. There are three things to look for: little black spots on the skin are the bites, little white things near the base of the pubic hair are the egg "nits". The little brown or gray insects crawling around are the mature crab lice.
Lice and nits can be removed either with forceps or by cutting the infested hair with scissors (with the exception of the eyebrow area). A magnifying glass or a stereo-microscope can be used for the exact location. If lice are detected in one family member, the entire family needs to be checked and only those who're infested with living lice should be treated.
- Shave and Groom: Shaving off or grooming any hair in the affected areas with a fine-toothed comb is necessary to ensure full removal of the dead lice, though neither treatment are sufficient on their own. You'll have to comb the nits several times a day while treating yourself with a natural topical solution like tea tree oil; however, mechanical removal, shaving or even washing excessively won't stop pubic lice. Pubic lice survive on blood and human blood alone, and they're going to cling to you no matter what, even if you've hardly any hair.As such, even though mechanical removal is the suggested primary treatment, you and many others should know how hard it is to get to "those hairs" beyond your taint. The only safe and painless solution to killing the lice and their eggs are medicated solutions sold over-the-counter in drug stores and pharmacies.
- Contact the Infected Person: Contact the person from whom you contracted the crab lice and let them know they need to get treated. Chances are, this person doesn't know he or she has crabs. Let the person know that he or she needs to check themselves out or see a doctor or he or she may have a worse infection than you.All partners with whom the patient has had sexual contact within the previous 30 days should be evaluated and treated. Sexual contact should be avoided until all partners have successfully completed treatment and are thought to be cured.Because of the strong association between the presence of pubic lice and classic sexually transmitted diseases (STDs), patients diagnosed with pubic lice should undergo evaluation for other STDs. Infection in a young child or teenager may indicate sexual abuse.
- Washing the Infected Laundry: Wash all of your underwear, pants, bedding and other laundry items with very hot water. You don't have to boil your clothes or anything, but make sure your washing machine is set to the hottest possible temperature. Also, make sure you wash every piece of fabric that you've come into contact with within the past few weeks. Don't forget to dry them in a hot dryer as well.
Pharmaceutical Treatments
- Topical Solutions and Medicated Creams: Theseare the prescribed medications for lice treatment. Truly, medicated creams like RID, Derbac-M, Prioderm and Quellada are really the only ways to kill the lice and their eggs, making sure they never return. These creams usually contain a chemical called Malathion, an insecticide. These solutions are spread around all hairy areas near your groin and left to soak for several hours. Repeat after two weeks to make sure the eggs are gone.These medications are usually available at your local pharmacy or drug store. Of course, if you're too embarrassed to make a request for these medicines in front of all the people at the store, there are several vendors on the Internet who'll make your "crab removal" a more discreet issue. This is great for people who live in small towns where sensitive information spread lightning fast.
- Permethrin: Crab lice can also be treated with Permethrin 1% cream rinse. Pyrethrins can be used for this purpose as well, and are the drugs of choice for pregnant or lactating women. Both these agents should be applied to the affected areas and washed off after 10 minutes.
Crab lice on the eyelashes can be treated with a permethrin formulation by applying the solution to the infested hair with an applicator. Keep in mind that it's dangerous to remove lice or eggs in the eyelashes by plucking or cutting the hairs. Resistance of pubic lice to pyrethroids must be if at all very rare. A second treatment after 10 days is recommended.
- Lindane Shampoo: Lindane shampoo (1%), a pediculocide, is FDA-approved as safe and effective when used as directed for the second-line treatment of pubic lice. While serious side effects have been reported, they're considered to be rare and have almost always resulted from misuse of medication, such as excessive application and oral ingestion.To minimize this risk, lindane medications are now dispensed in small, single-use bottles. The Centers for Disease Control and Prevention (CDC) note that lindane shouldn't be used immediately after a bath or shower, and shouldn't be used by persons who have extensive dermatitis, women who are pregnant or lactating or children aged under two years.The FDA similarly warns against use in patients with a history of uncontrolled seizure disorders and premature infants, and recommends cautious use in infants, children, the elderly, individuals with other skin conditions (e.g., atopic dermatitis, psoriasis) and in those who weigh less than 110 lbs (50 kg).
- Tea Tree Oil: Tea tree oil is nature's antiseptic. It's a powerful oil that kills just about anything it comes into contact with, not including your skin. Plus, it smells okay too, and it's not loaded with insecticides. This is almost a requirement if you're going to be using a nit comb to get rid of crabs, since it's often quite difficult to get to certain places with just a comb.
Pubic lice are the smaller cousin to head lice, and are talked about nowhere near as much; however, they have the potential to do much more damage because the skin is a lot more sensitive in that area. As such, follow the advice mentioned above, be more prudent with your sexual endeavors and call your doctor or dermatologist in the morning if symptoms or infestation persist.
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