Pubic lice and Scabies

Pubic lice are tiny parasitic insects that live in coarse body hair, such as pubic hair. They are yellow-grey and about 2mm long. They have a crab-like appearance, so they are often known as crabs. The eggs are called nits and appear as brownish dots fixed to coarse body hair. Pubic lice are different from the head lice which some people get on their scalp.

Scabies is caused by tiny parasitic mites. They are smaller than a pinhead and burrow into the skin and lay eggs. A more severe and uncommon form of the condition occurs when there are many mites in the skin. This is called crusted scabies, and can affect older people and people with certain illnesses, such as HIV infection.

Getting pubic lice and scabies is common. These infections are easily passed from one person to another through close body contact or sexual contact. Both men and women can get and pass them on, and it is possible for children to get scabies through close body contact.

This page gives you information about pubic lice and scabies, what you can do if you are worried that you might have them and advice on how to protect yourself.

Pubic lice and Scabies information

Click on a link to jump to the information.

• Pubic lice
• Scabies
• How can I help protect myself from sexually transmitted infections?
• When should I have a test for a sexually transmitted infection?
• Will I have to pay for tests and treatment?
• Will I know how long I've had pubic lice or scabies?
• Should I tell my partner?

Pubic lice

How do you get pubic lice?

Pubic lice have nothing to do with poor hygiene.

• Pubic lice can be passed from one person to another by close body or sexual contact with someone who has pubic lice.
• They can be found in pubic hair, underarm and leg hair, hair on the abdomen and chest, beards and rarely in eyebrows and eyelashes. They do not live in the hair on the head.
• Lice can live for up to 24 hours off the body. However, because pubic lice depend on human blood for survival, they will rarely leave the body unless there is close body contact with another person. Pubic lice move by crawling from hair to hair – they cannot fly or jump.
• It may be possible for pubic lice to be spread by sharing clothing, bedding and towels.

What are the signs and symptoms?

Some people will not have any symptoms, or may not notice the lice or eggs, so you may not know whether you or your partner have pubic lice.

It can take several weeks after coming into contact with pubic lice before signs and symptoms may appear. Signs and symptoms are the same for both men and women. You might notice:

• itching in the affected areas
• black powdery droppings from the lice in your underwear
• brown eggs on pubic or other body hair
• irritation and inflammation in the affected area, sometimes caused by scratching
• sky-blue spots (which disappear within a few days) or very tiny specks of blood on the skin.

You might see the lice, eggs or droppings, or your partner might notice them. Some people see pubic lice move, but they are tiny and difficult to see, and they keep still in the light.

Sometimes pubic lice will be noticed during a routine genital or medical examination even if a doctor or nurse isn't looking for them.

If I think I have pubic lice, how soon can I have a check-up?

You can have a check-up as soon as you have signs or symptoms for the doctor or nurse to look at, or if you think you might have been in contact with pubic lice. Some people won’t develop visible signs or symptoms straightaway and you may be asked to come back for another appointment later on.

What does the check-up involve?

In most cases, a doctor or nurse can tell if you have pubic lice just by looking. They may use a magnifying glass to look for lice and eggs, which are very small and may not be easily visible. The doctor or nurse may pick up a louse from the hair or skin and look at it under a microscope to check it is a pubic louse.

Where can I get a check-up?

There are a number of services you can go to. Choose the service you feel most comfortable with. A test can be done at:

• a genitourinary medicine (GUM) or sexual health clinic
• your general practice
• some contraception and and young people’s clinics.

If you know you have pubic lice you can go to a pharmacy for advice and treatment.

What is the treatment for pubic lice?

• Treatment for pubic lice is simple and involves using a special cream, lotion or shampoo. The doctor, nurse or pharmacist will advise you on what treatment to use and how to use it.
• You apply the cream, lotion or shampoo to the affected area and sometimes the whole body. Lotions tend to be more effective than shampoos. Some treatments can be rinsed off after 10–15 minutes; others are left on for longer.
• To be effective, treatment needs to be repeated after 3–7 days.
• You do not need to shave off pubic or other body hair.
• You should wash your clothing, bedding and towels in a washing machine on a very hot cycle (50°C or higher) to kill the lice and avoid re-infection.
• You can also buy treatments for pubic lice from pharmacies – these are useful for anyone who is sure they have pubic lice and wants to self-treat. The pharmacist will be able to advise if you have any questions, or are unsure how to use the treatment.
• If you do decide to treat yourself, you may want to consider having a sexual health check to make sure you don’t have a sexually transmitted infection.
• Do tell the doctor, nurse or pharmacist if you are, or think you might be, pregnant or if you are breastfeeding. This will affect the type of treatment you are given.
• There is currently no evidence that complementary therapies can cure pubic lice.
• Your sexual partner(s) should be treated at the same time even if they don't have any signs and symptoms.

When will the signs and symptoms go away?

If you use the treatment according to the instructions it is rare for it not to work.

Even after successful treatment, itching may continue for a few days. There may be nits in your body hair after treatment but these can be removed with a special comb that you can get from a pharmacy.

How soon can I have sex again?

It is strongly advised that you do not have any sexual intercourse, including vaginal, anal or oral sex, or close body contact, until you and your partner have both finished the treatment and any follow-up treatment. This is to help you being re-infected or passing the infection on to someone else.

Do I need to have a check-up to see if the pubic lice have gone?

It is advisable to have a check-up about a week after treatment to ensure that the pubic lice have gone. If the first treatment has not worked you may need to try another type as the lice can develop resistance.

Can pubic lice go away without treatment?

No. And if you delay seeking treatment you risk passing the condition on to someone else.

Does having pubic lice affect my fertility?

No.

What happens if I get pubic lice when I’m pregnant or while I’m breastfeeding?

Pubic lice can be treated while you are pregnant or breastfeeding, but not all types of treatment can be used. Your doctor, nurse or pharmacist will advise you. Permethrin cream is safe to use but if you are breastfeeding will need to be thoroughly washed off before any feed and re-applied if necessary.

Do pubic lice cause cervical cancer?

There is no evidence that pubic lice cause cervical cancer.

Scabies

How do you get scabies?

Scabies can be passed from one person to another by close body or sexual contact with someone who has scabies.

The mites which cause scabies can be found in the genital area, on the hands, between the fingers, on the wrists and elbows, underneath the arms, on the abdomen, on the breasts, around the nipples in women, on the feet and ankles, and around the buttocks.

The mites can live for up to 72 hours off the body, so it is possible for scabies to be spread by clothing, bedding and towels.

What are the signs and symptoms?

Some people will not have any visible signs or symptoms at all, or may not be aware of them.

It can take up to six weeks after coming into contact with scabies before signs and symptoms appear. Signs and symptoms are the same for both men and women. You might notice:

• Intense itching in the affected areas which may only be noticed at night, or which becomes worse in bed at night or after a hot bath or shower.
• An itchy red rash or tiny spots. Sometimes the diagnosis can be difficult because the rash can look like other itchy conditions, such as eczema.
• Inflammation or raw, broken skin in the affected areas – usually caused by scratching.

Scabies mites are very tiny and impossible to see with the naked eye. Fine silvery lines are sometimes visible in the skin where mites have burrowed.

Sometimes scabies will be noticed during a routine genital or medical examination even if a doctor or nurse isn't looking for it.

If I think I have scabies, how soon can I have a check-up?

You can only be certain you have scabies if you have a check-up. You can have a check-up as soon as you have signs or symptoms for the doctor or nurse to look at, or if you think you might have been in contact with scabies. Some people won’t develop visible signs or symptoms straightaway, and you may be asked to come back for another appointment later on.

What does the check-up involve?

A doctor or nurse can often tell if you have scabies just by looking at the affected areas. They may gently take a skin flake from one of the areas and look at it under a microscope to see if there is a mite present.

In some cases, treatment will be suggested if scabies is suspected, even if it cannot be confirmed.

Where can I get a check-up?

There are a number of services you can go to. Choose the service you feel most comfortable with. A test can be done at:

• a genitourinary medicine (GUM) or sexual health clinic
• your general practice; ask your doctor or practice nurse
• some contraception and young people’s clinics.

If you know you have scabies you can go to a pharmacy for advice and treatment.

What is the treatment for scabies?

• Treatment is simple and involves using a special cream or lotion. The doctor, nurse or pharmacist will advise you on what treatment to use and how to use it.
• You apply the cream or lotion usually to the whole body from the neck downwards. This ideally should be done overnight. The treatment should be rinsed off after 12 hours.
• You should wash clothing, bedding and towels in a washing machine on a very hot cycle (50°C higher) to kill the mites and avoid reinfection.
• You can also buy treatments for scabies from pharmacies. These are useful for anyone who is sure they have scabies and wants to self-treat. The pharmacist will be able to advise if you have any questions, or are unsure how to use the treatment.
• If you do decide to treat yourself, you may want to consider having a sexual health check at some point, to make sure you don’t have a sexually transmitted infection.
• Do tell the doctor, nurse or pharmacist if you are, or think you might be, pregnant or if you are breastfeeding. This will affect the type of treatment you are given.
• Close contacts in your household should be treated at the same time, as well as your sexual partner, even if they do not have any signs or symptoms.
• There is no evidence that complementary therapies can cure scabies.

When will the signs and symptoms go away?

If you use the treatment according to the instructions it is rare for it not to work.

Even after successful treatment, the itching or rash may continue for a few weeks. Special tablets or creams (antihistamines), or anti-irritant lotions such as calamine, can ease the itching.

How soon can I have sex again?

It is strongly advised that you do not have any sexual intercourse, including vaginal, anal or oral sex, or close body contact, until you and your partner have both finished the treatment and any follow-up treatment. This is to help you being re-infected or passing the infection on to someone else.

Do I need to have a check-up to see if the scabies has gone?

You may need to go back to check the scabies has gone away and that you have not come into contact with scabies again. If you have any questions, ask the doctor, nurse or pharmacist.

Can scabies go away without treatment?

No. And if you delay seeking treatment you risk passing the condition on to someone else.

Does having scabies affect my fertility?

No.

What happens if I get scabies when I’m pregnant or while I’m breastfeeding?

Scabies can be treated while you are pregnant or breastfeeding. However, not all types of treatment can be used. Your doctor, nurse or pharmacist will advise you. Permethrin cream is safe to use but if you are breastfeeding will need to be thoroughly washed off before any feed and re-applied if necessary.

Does scabies cause cervical cancer?

There is no evidence that scabies causes cervical cancer.

How can I help protect myself from sexually transmitted infections?

It is possible to get a sexually transmitted infection by having sex with someone who has an infection. This is possible even if they have no symptoms. The following measures will help protect you from most sexually transmitted infections, including HIV, chlamydia and gonorrhoea. If you have a sexually transmitted infection without knowing it they will also help prevent you from passing it on.

• Use condoms (male or female) every time you have vaginal or anal sex.
• If you have oral sex, cover the penis with a condom or the female genitals or male or female anus with a latex of polyurethane (soft plastic) square.
• If you are a woman and rub your vulva against your female partner's vulva one of you should cover the genitals with a latex or polyurethane square.
• If you are not sure how to use condoms correctly see our information about condoms, or call the FPA helpline.
• Avoid sharing sex toys. If you do share them, wash them or cover them with a new condom before anyone else uses them.

When should I have a test for a sexually transmitted infection?

If you, or your partner, think you may have a sexually transmitted infection it is important that you don't delay in getting a test.

You may wish to have a test if:

• you, or your partner, have or think you might have symptoms
• you have recently had unprotected sex with a new partner
• you, or your partner, have had unprotected sex with other partners
• during a vaginal examination your doctor or nurse says that the cells of the cervix are inflamed or there is a discharge
• a sexual partner tells you they have a sexually transmitted infection
• you have another sexually transmitted infection
• you are pregnant or planning a pregnancy.

Don't delay seeking advice - clinics don't mind doing sexual health check-ups.

Will I have to pay for tests and treatment?

All tests are free through NHS services. Treatment is also free unless you go to your general practice when you may have to pay a prescription charge for the treatment.

Will I know how long I've had pubic lice or scabies?

Sometimes it can be difficult to know where you got your pubic lice or scabies from. The check-up cannot tell you how long you have had them. If you feel upset or angry about having pubic lice or scabies, don't be afraid to discuss how you feel with the staff at the clinic or general practice.

Should I tell my partner?

If the test shows that you have pubic lice or scabies then it is important that your current sexual partner and any other recent partners are also checked and treated. The staff at the clinic or general practice can discuss this with you.

Last updated November 2012. Next update available October 2013.