Straight, No Chaser: Treatment of Pubic Lice (Crabs)

pubic lice treatment comb

There’s no dishonor in needing help. A pubic lice infestation is one of many types of conditions that can lead to a complete disruption of your life. These are full-time parasites whose mission is to multiply and inhabit you. If you get infected and either don’t know what to do or incompletely/incorrectly treat these infections, you’ll be in for a long and unpleasant co-existence with pubic lice. Today’s Straight, No Chaser addresses treatment considerations regarding pubic lice and is modified from recommendations from the Centers for Disease Control and Prevention. Non-treatment-related information on pubic lice is available in this post.
Lice-killing over-the-counter products containing 1% permethrin or pyrethrins and piperonyl butoxide can be used to treat pubic (“crab”) lice. These medications are safe and effective when used according to instructions. It never hurts to discuss this with the pharmacist while you’re there or with your expert consultant from home.
It is important to appreciate that there are two separate considerations in treating pubic lice: 1) treatment of lice actually in the pubic area and 2) treatment of lice on the eyebrows and/or eyelashes.
Steps for genital pubic lice treatment:

  • Wash the infested area and towel dry. Set the towel aside, as it will need to be specially cleaned.
  • Thoroughly saturate the pubic hair and other infested areas with lice medication. Leave the medication on your hair for the time recommended in the instructions. After waiting the recommended time, promptly remove it.
  • Even at this point, most nits (eggs) will still be attached to hair shafts. Nits may be removed with fingernails or by using a fine-toothed comb.
  • Put on clean underwear and clothing.
  • To kill any lice or nits remaining on clothing, towels, or bedding, machine-wash and machine-dry those items used during the two-three days before treatment. Use hot water (at least 130°F) and the hot dryer cycle.
  • Items that cannot be laundered can be dry-cleaned or stored in a sealed plastic bag for two weeks.
  • All sex partners from within the previous month should be informed that they are at risk for infestation and should be treated.
  • Sexual contact must be avoided until all sexual partners have been treated and reevaluated to rule out persistent infestation.
  • Repeat treatment in nine to 10 days if live lice or nits are still found.
  • Persons with pubic lice should be evaluated for other sexually transmitted diseases (STDs).

Steps for treatment of lice and nits found on eyebrows or eyelashes:

  • The lice medications used for the genital region should not be used near the eyes.
  • If only a few live lice and nits are present, it may be possible to remove these with fingernails or a nit comb.
  • If additional treatment is needed for lice or nits on the eyelashes, careful application of ophthalmic-grade petrolatum ointment (only available by prescription) on the eyelid margins two to four times a day for 10 days is effective. Regular petrolatum such as Vaseline should not be used, because it can irritate the eyes.

Your physician knows what medications work for treatment of pubic lice, but I do want you to make a note regarding one medicine: lindane shampoo. This medicine is effective but has a bad risk profile. It can be toxic to the brain and central nervous system and is most notably associated with the development of seizures. Because of this, lindane is not a first-line medication and should be restricted to instances in which other medications didn’t work or aren’t tolerated. Lindane is not to be given to anyone under 110 pounds (e.g., children), those with a history of seizures, women who are pregnant or breast-feeding, the elderly or those with sores and/or irritated skin in the areas to be treated.
The point about pubic lice is the same as with any sexually transmitted infection. Your best course is to avoid contracting it. If obtained, your best course is to come clean (no pun intended) and get aggressive with treatment and notification of your sexual partners. Pretending it will go away or that it can’t happen to you is a dangerous prescription that I won’t co-sign.
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