What percentage of people have pubic lice?

Everything You Need to Know About Crabs

When it comes to worrisome STDs, pubic lice—or «crabs» as they’re more commonly called—probably aren’t on the top of your list. Who gets crabs in 2017? That’s just for Woodstock hippies and World War II sailors on shore leave. It’s so rare that the Centers for Disease Control and Prevention «doesn’t conduct routine monitoring or surveillance for pubic lice,» according to Amy Rowland, a CDC spokeswoman.

The Daily Show mocked pubic lice as a «product of a bygone era,» and even serious health researchers have published studies with titles like «Pubic lice: an endangered species?» In that particular study, from 2014, researchers in the UK looked for correlations between pubic lice and a healthy briar patch down below. From their findings, reports of crabs have declined from 1.8 percent to 0.07 percent in a decade, and 94 percent of the patients with pubic lice had untended genital gardens. The «increased incidence of hair removal,» the researchers concluded, could only lead to the eventual «complete eradication» of crabs.

But to paraphrase Mark Twain, reports of the death of itchy pubes have been greatly exaggerated. The microscopic crab louse may be in decline, but it’s hardly gone. Some accounts estimate that up to 10 percent of the global population have crabs. Could that mean it won’t be long till crabs become a minor annoyance for sexually active adults yet again?

Pubic lice have been infesting human groins for at least three million years. To help you stay safe, here are answers to your most burning questions.

Are pubic lice different from head lice?
Head lice tend to be bigger, three millimeters in length compared to around one to 1.6 millimeter for pubic lice. And they each keep to their separate corners of the body, although pubic lice «can sometimes be found on coarse hair elsewhere on the body,» says the CDC’s Rowland. «For example, the eyebrows, eyelashes, beard, mustache, chest, and armpits.» But other than their size and human body real estate preferences, there’s not much difference. They’re both wingless parasitic insects that spread through human contact, attach themselves to hair shafts, and feast on human blood.

Why are they called «crabs»? They’re not mini-crustaceans, are they?
Nope. But viewed under a microscope, they vaguely resemble crabs. They’ve got six legs, a round body, and claws that allow them to cling to pubic hair. Honestly, we think they look way more menacing than a lowly crab. If it was up to us, we would’ve named them after the aquatic monster from the 1966 Godzilla movie Ebirah, Horror of the Deep. We’re totally not kidding. Look at this comparison: The top image is a microscope mugshot of the crab louse, the bottom is the Godzilla baddie Ebirah.

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How do I know if I’ve got Ebirah, Horror of… I mean crabs? Is it just itching, or is there another symptom I should look for?
Itching is the main symptom. You might catch a glimpse of the little fuckers, if you know what to look for. They’re tan to grayish-white, they cling to the roots of your pubic hairs, and they’re very, very, very small. Unless you’re in the habit of staring at your crotch, you probably wouldn’t notice them. At least not until the itching starts. The itching is one of those, «Whoa, that doesn’t feel right» red flags. It usually begins five days after the crabs have set up shop in your pubes.

The itching is basically skin irritation, caused by those pesky parasites biting into your skin and injecting their saliva, which helps gets the blood flowing in their direction. The itching is worse at night, because that’s when crabs like to burrow. They prefer a host that isn’t moving as much. So while you sleep, the tiny creatures from a Godzilla movie that live in your pubic shrubbery are feeding on your body like vampires, but only in the tiny patch of hairy skin just above the most sensitive organ on your body.

Okay, I hate everything about this. How do I make the crabs go away?
You don’t need a doctor to get rid of them, but you should probably go anyway. (We’ll get to that in a minute.) Pubic lice is easily treated with an over-the-counter lice shampoo. They’re pretty easy to find, anywhere from Amazon to Walmart. Just make sure it contains «1 percent permethrin or a mousse containing pyrethrins and piperonyl butoxide,» Rowland says. «These medications are safe and effective when used exactly according to the instructions in the package or on the label.»

Great. I Amazon Primed that shit before I finished that last paragraph. Now I’m fine, right?
Well, don’t get too relaxed. «Even after treatment, most nits or eggs will remain attached to the hair,» says Fred Wyand, a spokesperson for the American Sexual Health Association. «Nits can be removed with fingernails or a fine-tooth comb. And your clothes and bedding may still be infested with crabs.»

They’re in my bed?
Relax! We’re not saying you need to bug-bomb your house. Just do a load of laundry. You can handle that, right? Rowland also recommends «not sharing clothing, bedding, and towels used by an infested person,» but you probably didn’t need us to tell you that, right? If you think somebody gave you crabs, maybe the last thing you should be saying to them is, «Hey, throw me that wet towel when you’re done with it, kay?»

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What about toilet seats? Can I get crabs from a toilet seat?
No.

Are you sure?
We’re very sure. Rowland calls this a «common misconception.» Which is a nice way of saying, «I am so tired of hearing this crap.» «This would be extremely rare because lice cannot live long away from a warm human body and they do not have feet designed to hold onto or walk on smooth surfaces such as toilet seats,» Rowland says, rationally.

Are crabs dangerous? Can it lead to something more serious?
Well, that’s two different questions, isn’t it? In and of itself, crabs are harmless. They’re more a nuisance than a cause for medical alarm. But that said, if you have crabs, it wouldn’t be the worst decision to make an appointment with your family doctor anyway.

Why?
«While crabs are not always sexually transmitted, most cases are acquired sexually, and STDs in general tend to be more common in those with pubic lice,» Wyand says. Which is a nice way of saying, if your partner has crabs, it’d be a mistake to think, «Well at least that’s all they have.» Just go get tested, okay?

Pubic lice

Pubic lice are very small (2mm long) and grey-brown in colour.

They can be hard to spot, but sometimes you may be able to see them in your hair.

They most often live on pubic hair around the penis or vagina, but can also be found in hair on the chest, armpits, face and eyelashes. They do not affect hair on the head.

Other symptoms of pubic lice include:

itching, which is usually worse at night
small red or blue spots on your skin (lice bites)
white/yellow dots attached to your hair (lice eggs)
dark red or brown spots in your underwear (lice poo)
crusted or sticky eyelashes, if they’re affected

Non-urgent advice: Go to a sexual health clinic or see a GP if:

you think you might have pubic lice

Pubic lice will not go away without treatment.

If you’re sure you have pubic lice, you may be able to get treatment from a pharmacist.

What happens at your appointment

If you go to a sexual health clinic or GP surgery because you think you have pubic lice, a doctor or nurse will check your hair for lice.

They may check your pubic hair around your penis or vagina and any other areas that could be affected, such as your armpits, chest or eyelashes.

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To help spot any lice, they might use a comb and a magnifying lens.

If they think you might have caught the lice during sex, they may ask about your sexual partners. They may also suggest getting tested for any sexually transmitted infections (STIs).

Treatment for pubic lice

The main treatments for pubic lice are medicated creams or shampoos that kill the lice.

You usually need to use the treatment on your whole body and leave it on for a few hours before washing it off. You’ll need to repeat this again a week later to make sure all the lice have been killed.

You may be asked to come back a week after you finish treatment, to check if the treatment has worked.

Any current or recent sexual partners should also be treated, even if they do not have symptoms.

How to stop pubic lice spreading

While you’re being treated for pubic lice, there are some things you can do to help stop the lice spreading to others and stop the lice coming back.

Don’t

How you get pubic lice

Pubic lice are mainly spread by close body contact, most commonly sexual contact.

The lice cannot jump or fly, but can climb from one person to another.

You can also catch the lice from clothes, bedding or towels used by someone with pubic lice, but this is rare.

How to avoid getting pubic lice

It can be hard to prevent pubic lice.

The only way to avoid getting them is to avoid having sexual contact (or sharing bedding or clothing) with anyone you know who has pubic lice, until they’ve been treated.

Condoms and other forms of contraception will not protect you from pubic lice. But it’s still a good idea to use condoms during sex because they reduce the risk of sexually transmitted infections (STIs).

Page last reviewed: 24 May 2022
Next review due: 24 May 2025

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How can you protect yourself and others from pubic lice?

Pubic lice pass from person to person, especially during sex and close skin contact. You don’t have to take special measures to protect yourself. But if you find pubic lice on your body, you should take care not to pass the parasites on to others.

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Pubic lice are usually noticeable because they cause itching and leave blueish-gray or red bite marks in the genital area. The insects themselves and their eggs (nits) can be seen with the naked eye.

You can get rid of the parasites with a simple treatment, but it is still important to protect others and tell people who you might have passed the pubic lice on to.

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Lots of people shave or otherwise remove their pubic and armpit hair and hair on other parts of the body like the legs and chest for aesthetic reasons. That lowers the risk of infestation because the pubic lice have less chance to cling on. But even shaving off all of your pubic hair doesn’t provide one hundred percent protection because pubic lice can survive in hair on other parts of the body – even on eyebrows and eyelashes.

It isn’t necessary to disinfect flat surfaces or objects like toilet seats that the lice can’t cling on, or to disinfect entire rooms.

Condoms do protect from other sexually transmitted infections. But they can’t prevent pubic lice from spreading.

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To make sure you don’t pass the parasites on to other people, it is important not to have sex until you are sure that treatment has got rid of all of the pubic lice.

But you can already pass on pubic lice before you even notice them. That’s why it is important to tell everyone you had sex with in the three months before the diagnosis . They can then examine themselves and get treatment if needed.

Steady sexual partners are usually treated at the same time so that the pubic lice are not passed back and forth.

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Infection through textiles is rare, but possible, especially through bedding, towels and clothes. The lice can cling on to the fibers in the laundry. They can only survive for about 1 to 2 days without direct contact to a human body, but their eggs (nits) can survive for a longer time.

If you use the same bedding after treatment as you were using before, wear clothes you’d already worn, or use the same bath towel, lice or nits that have survived might make it back onto your body. That is also true for other people who use those textiles.

Washing laundry at 60 degrees Celsius gets rid of the parasites. Another option, such as for sensitive textiles, is to seal them in a plastic bag for two weeks and wait for the pubic lice and nits to die.

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Sources

Centers for Disease Control and Prevention (CDC). Pubic «Crab» lice: Frequently Asked Questions (FAQs) . 2020.

Coates SJ, Thomas C, Chosidow O et al. Ectoparasites: Pediculosis and tungiasis . J Am Acad Dermatol 2020; 82(3): 551-569.

Dholakia S, Buckler J, Jeans JP et al. Pubic lice: an endangered species? Sex Transm Dis 2014; 41(6): 388-391.

Markova A, Kam SA, Miller DD et al. In the clinic. Common cutaneous parasites . Ann Intern Med 2014; 161(5).

Salavastru CM, Chosidow O, Janier M et al. European guideline for the management of pediculosis pubis . J Eur Acad Dermatol Venereol 2017; 31(9): 1425-1428.

Workowski KA, Bachmann LH, Chan PA et al. Sexually Transmitted Infections Treatment Guidelines, 2021 . MMWR Recomm Rep 2021; 70(4): 1-187.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods .

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How can you protect yourself and others from pubic lice?