Pubic lice (crabs): symptoms, causes and treatment

Few things cause more quiet embarrassment than pubic lice — and few things deserve it less. They’re common, they’re harmless, they don’t carry disease, and they have nothing to do with how clean you are. They’re also straightforward to treat. Here’s what to look for, how they spread, and the simple steps that clear them.

What are pubic lice (crabs)?

Pubic lice are tiny insects that live in coarse body hair and feed on blood, causing itching. They’re nicknamed “crabs” because of their broad, crab-like shape. They mainly live in pubic hair but can affect other coarse hair too. They’re common, harmless, and — importantly — nothing to do with poor hygiene. They don’t carry disease and are easily treated.

What they look like

Look for three things: the lice themselves (about 1–2 mm, greyish-brown, crab-shaped, clinging to the base of hairs); the eggs (tiny pale specks firmly attached to hair bases); and signs of their presence (small bluish spots or specks of blood on the skin, and dark powdery droppings in underwear).

Symptoms, how you get them, and STI status

The main symptom is itching, often worse at night, which can take a week or two to start. Pubic lice spread mainly through close body contact, especially sexual contact; less commonly through shared bedding or towels. They can’t jump or fly — they crawl — so close contact is what passes them on. Because they’re usually passed on sexually, they count among the STIs, which makes having them a sensible prompt to consider a full STI check for other, often silent, infections while you’re being seen.

How they’re treated

Pubic lice are cleared with a topical anti-lice treatment applied to the affected areas, repeated after about a week to catch newly hatched lice (a common reason they seem to come back). You don’t need to shave. Treat sexual partners and close household contacts at the same time, and avoid close contact until everyone has been treated, otherwise lice get passed back and forth. Wash bedding, towels and recently worn clothing on a hot cycle, or seal items that can’t be washed in a bag for a couple of weeks — there’s no need to fumigate your home.

Eyelashes and other areas

Occasionally pubic lice affect the eyelashes or eyebrows. This area needs a different, gentler approach — the lotions used elsewhere should not go near the eyes — so eyelash involvement should be assessed by a clinician rather than self-treated.

When to see a doctor

See a clinician if you’re unsure whether you have pubic lice, if they don’t clear after two proper rounds of treatment, if the skin becomes very inflamed or looks infected from scratching, if the eyelashes or eyebrows are affected, or if you’re pregnant or breastfeeding and need advice on suitable treatment. It’s also a good opportunity to arrange a broader STI check.

Common questions

What are pubic lice (crabs)?

Pubic lice are tiny insects that live in coarse body hair and feed on blood, causing itching. They’re called crabs because of their broad, crab-like shape with claw-like legs. They mainly live in pubic hair but can affect other coarse hair too. They’re common, harmless, not a sign of poor hygiene, don’t carry disease, and are easily treated.

What are the symptoms of pubic lice?

The main symptom is itching in the affected area, often worse at night, caused by an allergic reaction to the bites. It can take a week or two after getting them for itching to start. Other symptoms include visible lice or eggs, small bluish spots or specks of blood on the skin, dark droppings in underwear, and mild irritation, sometimes worse from scratching.

How do you get pubic lice, and are they an STI?

Pubic lice spread mainly through close body contact, especially sexual contact. Less commonly they spread via shared bedding, towels or clothing, though they don’t survive long off the body. Because they’re most often passed on sexually, they count among the STIs — though not one caused by bacteria or a virus. Having them is a sensible prompt to consider a full STI check.

Are pubic lice a sign of poor hygiene?

No. Pubic lice have nothing to do with hygiene or cleanliness — anyone can get them, as they simply need coarse hair and close contact to spread. Washing more won’t get rid of them, and having them isn’t a reflection on you. They’re common and treatable, and there’s no reason to feel embarrassed about seeking treatment.

How do you get rid of pubic lice?

With a topical anti-lice treatment applied to all affected areas. Apply it as directed, then repeat after about a week to catch newly hatched lice (a common reason they seem to return). You don’t need to shave. Treat everyone affected at the same time to avoid passing them back and forth.

Do I need to treat my partner, and what about bedding?

Yes — treat sexual partners and close household contacts at the same time, and avoid close contact until everyone has been treated. Wash bedding, towels and recently worn clothing on a hot cycle, or seal items that can’t be washed in a plastic bag for a couple of weeks. There’s no need to fumigate your home — pubic lice don’t survive long away from the body.

Are pubic lice the same as head lice?

No — they’re a different type of louse. Pubic lice live in coarse body hair and are spread mainly by close body contact, while head lice live on the scalp and are common in children. Having one doesn’t mean you have the other, and they’re treated as separate things.

Can pubic lice affect the eyelashes?

Occasionally, yes. Pubic lice can affect the eyelashes or eyebrows, and this area needs a different, gentler approach — the standard lotions used elsewhere should not be put near the eyes. So eyelash involvement should be assessed and managed by a clinician rather than self-treated.