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Pubic lice treatments

What is pubic lice?

Pubic lice, sometimes called crabs, are small insects that live on coarser body hair, most commonly the pubic hair around the genitals. They're spread through close body contact, most commonly sexual contact.

Pubic lice are around 2mm long and greyish brown in colour. They most often live in pubic hair, but they can also be found in hair on the chest, armpits, face and, occasionally, the eyebrows or eyelashes. They don't live in the hair on the head, which is what separates them from head lice, an unrelated type of louse.

Pubic lice can't jump or fly. They move by crawling and gripping onto hair with small claw-like legs, which is why close, direct body contact is needed for them to spread from one person to another.

Available treatment approaches

• Medicated lotions, creams and shampoos to kill lice and eggs
• Guidance on laundry and household measures to stop lice spreading
• Partner notification and sexual health support
• Foundations of sexual health

How the assessment process works

1. Complete a short, secure medical questionnaire.
2. Select a treatment category for assessment.
3. An independent UK-registered prescriber reviews your information and determines whether medical treatment may be appropriate.
4. Next steps are arranged following clinical approval.

Understanding pubic lice and treatment options

Pubic lice are more common than many people realise, and having them isn't a reflection of personal hygiene. The main symptom is itching in the affected area, which tends to be worse at night when the lice are most active. Other signs include small red or blue-ish bite marks on the skin, pale eggs attached firmly to individual hairs, and small dark spots of lice droppings in underwear.

Pubic lice are spread almost exclusively through close body contact, most commonly during sexual contact. Because they crawl rather than jump, they need skin-to-skin or hair-to-hair contact to move between people. Less commonly, they can spread through shared towels, bedding or clothing that's been in close contact with someone with an active infestation.

Condoms don't prevent pubic lice, as the lice can still move across areas of skin and hair that a condom doesn't cover. Condoms remain an important way to reduce the risk of many other sexually transmitted infections, so they're still worth using.

Pubic lice will not clear up without treatment, but they respond well to medicated lotions, creams or shampoos when used correctly.

Pubic lice isn't itself classed as a sexually transmitted infection, but because it's usually caught through sexual contact, it's worth considering an STI test if there's a chance you've also been exposed to something else. A sexual health clinic can offer this alongside confidential advice.

How pubic lice is diagnosed

Pubic lice is usually diagnosed through a visual examination of the affected hair, sometimes using a magnifying glass or fine-toothed comb to spot lice or eggs more clearly. Itching alone isn't always a reliable sign, so a proper look, either at home or by a clinician, is the best way to confirm what's going on.

When should pubic lice be treated?

Treatment should begin as soon as pubic lice is confirmed or strongly suspected, since the condition won't resolve on its own. Most cases can be managed with a medicated lotion, cream or shampoo applied to the whole body, though the eyebrows and eyelashes always need a different approach.

Shaving pubic hair isn't required and isn't a substitute for proper treatment.

Which healthcare professionals can support pubic lice treatment?

Depending on individual circumstances, different healthcare professionals may be involved in diagnosis and treatment.

General practitioner (GP)

Can diagnose and treat pubic lice and provide referrals to specialist sexual health services where needed.

Sexual health clinician

Specialist sexual health and GUM clinics offer confidential examination, treatment and advice on partner notification, along with STI testing where relevant.

UK-registered online prescriber

A UK-registered prescriber can assess suitability for treatment through a secure online process following a clinical questionnaire.

Pharmacist

Can advise on suitable over-the-counter treatments and how to apply them correctly, and can flag when a GP or clinic visit is needed instead.

How is pubic lice managed?

Management of pubic lice typically involves a combination of correct treatment application, household measures and partner notification.

• Antiparasitic treatment: A medicated lotion, cream or shampoo applied according to the product leaflet, usually to the whole body but never to the eyebrows or eyelashes
• Repeat application: Most treatments need a second application around a week after the first, to catch any eggs that have hatched since
• Partner notification: Current and recent sexual partners should be checked and treated as advised, even if they have no symptoms
• Laundry and environment: Washing clothing, towels and bedding at 50°C or higher, dry-cleaning items that can't be washed at high temperatures, or sealing them in a plastic bag for at least two weeks, along with vacuuming mattresses and soft furnishings
• Avoiding shared items: Not sharing clothing, bedding, towels or razors with others while lice are present

Treatment checklist

When to seek further advice

While many cases of pubic lice can be managed with an over-the-counter or prescribed treatment, there are times when it's best to get input from a pharmacist, clinician or sexual health clinic rather than treating at home. This includes if you're not sure the diagnosis is right, if you're pregnant or breastfeeding, if the person affected is a child, if lice appear on the eyebrows or eyelashes, if the skin looks infected or is badly irritated, or if treatment doesn't seem to have worked or lice keep coming back. If there's a chance you've also been exposed to an STI, a confidential NHS sexual health clinic can offer testing alongside lice treatment.

A pharmacist can usually advise on suitable over-the-counter options for straightforward cases, while a GP or sexual health clinic is the right route where any of the above apply, or where you'd simply prefer an in-person assessment.

Medicines that may be considered

Where clinically appropriate, a pharmacist or UK-registered prescriber may recommend an antiparasitic lotion, cream or shampoo for pubic lice. Suitability depends on individual health profile, the area affected, and current clinical guidance. Exact application instructions, including how long a product should be left on and whether a repeat application is needed, are set out on the specific product leaflet and should always be followed closely.

Lice affecting the eyebrows or eyelashes require a different approach to lice elsewhere on the body, and should be discussed with a pharmacist, clinician or optometrist rather than treated with a standard lotion.

How DoktorABC UK supports access to care

DoktorABC UK is a digital health platform that connects patients with independent, UK-registered healthcare professionals. Patients can access a clinical assessment through a secure online process.

A UK-registered prescriber reviews the information you provide and determines whether treatment may be appropriate for you. If treatment is considered suitable, a prescription is issued by the UK-registered prescriber in accordance with UK regulations, and any medication is dispensed through a GPhC-registered pharmacy.

DoktorABC UK does not itself provide medical care, issue prescriptions or dispense medicines. All clinical decisions are made by the independent prescribing healthcare professional following an individual assessment.

Summary

Pubic lice is a common condition that responds well to treatment when the correct medicated lotion, cream or shampoo is applied and any repeat application is completed as directed. Partner notification and simple household measures, such as washing bedding and clothing at a high temperature, help prevent reinfection and further spread. Lice on the eyebrows or eyelashes need specific professional advice rather than standard body treatment. A UK-registered prescriber or pharmacist can assess your individual circumstances and advise on the most appropriate treatment.