Pubic Lice and Genital Scabies

Pubic lice (also sometimes called crabs) are parasite insects that infest the pubic hair. Genital scabies are mites that infest the genital skin. They are both a type of sexually transmissible infection (STI).

Pubic lice and genital scabies are mainly passed on during sexual skin-to-skin contact with someone who has pubic lice or genital scabies. Sexual skin-to-skin contact may be during genital-to-genital contact, vaginal, anal or oral sex or sharing sex toys.

Pubic lice and genital scabies can affect anyone who is sexually active. Pubic lice and genital scabies can survive away from the body for up to 3 days, so it is possible they may be passed on from sharing items such as bed linen, clothing and towels.

Most people with pubic lice and genital scabies experience itchiness in the affected genital area. With scabies, this is especially at night or after a hot bath or shower.

Some people may have symptoms such as:

• a rash, bumps or redness on the genital skin (which is more likely with scabies as they burrow into the skin to lay eggs)
• fever
• sleep disturbance, tiredness.

If you have pubic lice you may notice lice, eggs or nits (empty eggshell) in the pubic hair or underwear. Lice eggs and nits usually strongly attach to the base of hairs (close to the skin).

Pubic lice and genital scabies are diagnosed by a doctor or nurse, who will examine the affected area and any rash, bumps or redness you have noticed.

If the doctor thinks you have genital scabies, they will take a skin scraping (a small sample of skin taken with a fine needle) to confirm.

You may choose to test for other STIs or BBVs at the same time as testing for pubic lice and genital scabies.

Sexual Health Victoria (SHV) provides expert, confidential STI and BBV testing to Victorians. For more information on SHV clinical services, see our clinics or you can book an appointment online.

Pubic lice and genital scabies are treated with a cream or lotion to the affected area. Treatment may need to be repeated after 1 week.

In addition, it may be recommended you:

• Avoid close body contact including sexual contact for 7 days after you (and your current sexual partner/s) have finished treatment and symptoms have resolved.
• Remove and wash clothes, towels and bed linen. Or store in a plastic bag for 1 week while pubic lice (crabs) and genital scabies die.
• Use other medications to ease or soothe itching (e.g. antihistamine oral medication, calamine lotion and topical steroid creams).

Your doctor or nurse will give you the pubic lice (crabs) and genital scabies treatments or you can buy them over the counter at a pharmacy without a script.

If untreated, pubic lice (crabs) and genital scabies can cause a persistent itch, which can lead to sores and bacterial skin infection.

Breaks in skin due to scratching or infection can increase the risk of getting other sexually transmissible infections.

Pubic lice and genital scabies are cured by effective treatment, but you do not develop any immunity. It is possible to get another infection.

To avoid being reinfected with pubic lice or genital scabies, it is recommended you avoid sexual contact or use barrier protection (external condoms, internal condoms or dental dams) for 7 days after you (and your current sexual partners) have finished treatment.

The symptoms of genital scabies may persist for 2 – 3 weeks after treatment as your immune system responds to the scabies. If symptoms persist for longer, you can see your doctor or nurse.

Safer sex, including regular STI (and BBV) testing is the best way to lower your risk of getting pubic lice (crabs) and genital scabies.

Advice for disclosing

• Be as informed as you can
• Don't try and have this conversation when you are about to have sex
• Choose a place and time when you know there will be no interruptions and when you're feeling calm and relaxed

There are some great websites to support you informing your sexual partners via a phone call, text message, letter or email. There are ways of doing this either personally or anonymously.

• Let Them Know
• The Drama Downunder – for men who have sex with men
• Better to know – for Aboriginal and Torres Strait Islander people

Your doctor or nurse can assist with informing your current or previous sexual partners.

If you are infected with pubic lice or genital scabies during pregnancy or breastfeeding, it usually does not cause any health complications for you and your baby.

If you are pregnant or breastfeeding and considering treatment for an STI or BBV, ask your doctor, nurse or midwife about the possible effects of the treatment or medicine on your baby or breastfeeding. Pubic lice and genital scabies treatment is usually safe to use while pregnant or breastfeeding.

If you are planning a pregnancy or already pregnant, testing for pubic lice and genital scabies is not a routine part of health care. It is recommended you and your sexual partner/s have other STI and BBV screening tests, even if you have been tested in the past. You can book an appointment with us, or speak to your doctor, nurse or midwife for more information.

You can lower your risk of getting STIs and BBVs by using barrier protection (external condoms, internal condoms or dental dams) correctly during any type of sex (vaginal, anal or oral sex) and when sharing sex toys.

Barrier protection is not 100% effective at preventing STIs and BBVs.

You can also lower your risk of getting a BBV by:

• not sharing injecting equipment, razors, nail clippers
• only getting tattoos and piercing in regulated places
• talking to your doctor or nurse about HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) if you are at risk of HIV exposure.

You can also lower your risk of getting an STI or BBV by both you and your sexual partners having regular STI and BBV testing. To get an STI or BBV test at Sexual Health Victoria, see our clinics or you can book an appointment online.

• Sexual Health Victoria
• Better Health Channel
• The Centre Clinic – a safe and friendly general practice, providing care for LGBTI community members as well as specialist medical care for people living with hepatitis, and expert sexual health screening and treatment.
• DirectLine 1800 888 236 – support for people affected by alcohol and other drugs including information on where to obtain new needles and syringes.
• Equinox – for transgender services
• Headspace – for young people
• Melbourne Sexual Health Centre – a specialist sexual health clinic.
• Minus 18 – for young lesbian, gay, bi-sexual, transgender and intersex (LGBTI) people.
• Multicultural Centre for Women’s Health – for culturally and linguistically diverse women.
• PRONTO! – a peer-led service for men who have sex with men.
• Thorne Harbour Health (formerly Victorian AIDS Council)
• TouchBase – information, support and services for LGBTI people.
• A doctor or nurse.
• Your local community health service.

If you are using the internet for information, only use reliable and reputable websites. Be aware of websites containing inaccurate and harmful information and imagery.