I was quite shocked that crabs (AKA pubic lice) is as prevalent as it is. But in the past week I have been asked about it three different times from people all over the US, which made me think that this topic needed a little discussion related to what crabs are, how you get them, and how to treat them.  I wasn’t sure how prevalent they are, but they are clearly around, and infections are on the rise.

What are crabs?

Crabs are also known as pubic lice (Pthrius pubis) and they are parasitic insects that feast off the blood of humans and live in coarse hair (i.e. pubic hair, eyebrows, eyelashes, chest hair, armpits, mustaches, & beards) causing itching, discomfort, and rashes. So you can understand how they can not only be really irritating, awkward, and kind of gross to think about, right?  They pass from person to person usually through sexual intercourse (or sexual acts) but they can also jump from person to person through hugging or other close contact (sharing towels, clothes, bedding, etc.) Despite the fact that crabs can’t live very long away from the warmth of a human body, they are still the most contagious STD, and if an infected person has sex with a non-infected person, the risk of getting crabs is about 90% for that previously non-infected person.  That is pretty shocking, and horrifying…a 90% chance?!?  Plus the lice live from about 1 to 3 months, and in that “lifetime” the average female lice has about 300 eggs, which means they breed quickly and frequently! These parasites spread quickly.

What are the signs and symptoms of infection?

Usually the only symptom is itching….extreme itching.  Sometimes you can visualize the bite marks on your skin, they are bluish in color, due to the bruising from them sucking your blood to the surface, but it is very hard to see. Sometimes there are little red bumps from the bites, and then scratching them. Most often the itching and discomfort brings people in to their HCP.

How do I treat it?

First, when you find out that you are infected, let the people you live with and sexual partners know about the crabs, and clean all sheets, clothing, towels, etc in water that is at least 130F and dry it thoroughly in a dryer to kill off the lice living in the sheets.  If some of these items cannot be washed, then have them dry cleaned.  You can also buy an over the counter (OTC) treatment from your local pharmacy, like Permethrin 1% creme, that you apply to the affected areas (not near eyes), leave on for 10 minutes, then wash out and with a fine toothed comb, comb through the hair to remove all eggs and dead lice.  Usually this one time treatment works, but you MUST see an HCP to get treatment if the OTC doesn’t work, if you are pregnant, children under 2 years old, or teens under 18.  There are some treatments that are prescription only, so you need to see your HCP and get diagnosed. One other option, after you treat the area, is to shave off all affected areas (this is a little radical and not usually suggested by most HCPs) but if there is no hair to cling onto, there will be no pubic lice….just make sure to kill off the current infestation you have. Makes sense right?

Can I prevent it?

Well, you can ask partners if they have crabs, which I would hope they would abstain from sexual contact if they knew they had crabs, but its worth an ask.  Unfortunately, condoms do not prevent the spread of crabs, which is a total bummer.  If you have previously been infected (or are infected currently), make sure to wash or dry clean everything (as stated above, use the OTC treatment, and if symptoms are not cleared up, go see your HCP for further treatment, and bleach your bathroom/anything you use on your hair/body hair for grooming.

So unfortunately, it is highly contagious and can be an awkward treatment, but limiting your sexual partners, and asking about STD’s is a start at prevention.  Also, use your intuition: if you see someone scratching their crotch or just all over when you’re out with them, ask them if they have some sort of skin issue or lice.  If they say they are just super itchy and they don’t know why?  Steer clear!!

Yours in Good Health

B