Crabs - Treating pubic lice

Pubic lice can be treated at home with insecticide cream, lotion or shampoo. It will usually need to be applied once and repeated after three to seven days.

Some treatments only need to be applied to the affected area, but sometimes the whole body must be treated, taking care to avoid the eyes. Your doctor, nurse or pharmacist can give you more advice about this.

Everyone you have had close bodily contact with should also be treated at the same time. This includes any sexual partners you have had in the past three months and all members of your household. 

Sometimes pubic lice can be difficult to get rid of because they can develop resistance to insecticide treatments. If this is the case, you may need to try more than one type of treatment. Your doctor or pharmacist can advise you on suitable alternatives.

Washing clothing and bedding

It's important to wash any clothing and bedding, including towels, in a washing machine. This should be on a hot cycle (50ºC or higher) to make sure the lice are killed to help prevent reinfection.

Treating yourself

You can treat yourself at home with an insecticide cream, lotion or shampoo. They are available on prescription from your doctor, or you can buy them over the counter from your pharmacy.

Before using the treatment, speak to your doctor or pharmacist about the correct way to use it. Follow their instructions, even if they are different to those on the packaging. 

Always ask for advice if the treatment is for:

• a child under 18 years of age
• someone who is pregnant or breastfeeding

These people may require a specific type of treatment. 

Applying a lotion, cream or shampoo

In most cases the instructions for using a lotion, cream or shampoo will be as follows:

• apply the product to the affected area, particularly any hairy areas, such as your eyebrows, beard or moustache – depending on the product, you might need to apply it to your whole body, including the scalp, neck, ears and face
• be careful not to get the product in your eyes – if you do, rinse your eyes thoroughly with water
• reapply the treatment if you wash any part of your body during the treatment time
• after the correct treatment time (stated on the packet) has passed, wash the lotion or cream off
• repeat the treatment after three to seven days as instructed

Do not use the medication more than twice.

Treating an eyelash infestation

If your eyelashes are infested, seek specialist advice and help from your doctor.

You cannot use the same insecticide lotion or cream that you use on your body as this will irritate your eyes. Your doctor will be able to recommend an alternative treatment for you.

Eye ointment

An eye ointment with a white or yellow soft paraffin base may be recommended. This works by coating the lice in the greasy ointment and suffocating them. You should:

• apply the ointment to your eyelashes twice a day, ensuring that all your eyelashes are well covered
• each time you reapply the ointment, first gently wipe your eyelashes and eyelids clean with a tissue, and throw the tissue away afterwards
• continue the treatment for at least eight days
• continue the treatment for 10 days if you can still see lice or unhatched eggs (not empty eggshells or dead nits) – the eggs can take this long to hatch 

Side effects

Insecticides that are used to treat pubic lice may cause skin or eye irritation, such as itchiness, redness, stinging or burning.

If you have these side effects, wash the insecticide off the irritated area. If the insecticide gets into your eyes, rinse them thoroughly using plenty of water.

Some aqueous and alcohol-based medications may discolour permed, coloured or bleached hair. Check the patient information leaflet for more details.

Follow-up treatment

The first treatment application will probably kill the lice, but the eggs may not have been destroyed. This means that more lice could hatch and the cycle will start again.

Reapplying the treatment after seven days ensures that any lice are killed before they are old enough to lay more eggs.

Check for lice a week after your second treatment, or return to your doctor, sexual health clinic or genitourinary medicine (GUM) clinic so they can check for you.

If you find empty eggshells (dead nits), it does not necessarily mean that you are still infested. They can remain stuck to the hairs even after treatment.

Sometimes lice may be resistant to the treatment used and your doctor may recommend a different treatment.

Treating other people

To prevent reinfestation, anyone that you are in close contact with should also be treated at the same time as you. This includes your sexual partners and all members of your household, even if they do not have symptoms.

Infestations from sexual contact

Your GP may refer you to a GUM clinic so you can be screened for other sexually transmitted infections (STIs), such as chlamydia. 

Staff at the clinic will recommend that you inform any sexual partners you have had in the past three months so they can also be examined for pubic lice and treated if necessary.

Some people feel angry, upset or embarrassed about talking to their current or former sexual partners about pubic lice. Do not be afraid to discuss your concerns with clinic staff. They can help you decide the best way to make contact. They can also contact a partner without releasing your details, if you prefer.