Causal Agent:

Phthirus pubis, the pubic or crab louse, is an insect of the order Psocodea and is an ectoparasite
whose only host are humans.
Life Cycle:

Pubic lice (Phthirus pubis) have three stages: egg, nymph and adult. Eggs (nits) are laid on a hair
shaft . Females will lay approximately 30 eggs during their 34 week life span. Eggs hatch
after about a week and become nymphs, which look like smaller versions of the adults. The
nymphs undergo three molts ( , , ) before becoming adults . Adults are 1.52.0 mm long
and flattened. They are much broader in comparison to head and body lice. Adults are found only
on the human host and require human blood to survive. If adults are forced off the host, they will
die within 2448 hours without a blood feeding. Pubic lice are transmitted from person to person
most-commonly via sexual contact, although fomites (bedding, clothing) may play a minor role
in their transmission.

Lice
Lice (pediculosis) can infect the scalp, body, pubis, and eyelashes. Head lice are
transmitted by close contact; body lice are transmitted in cramped, crowded
conditions; and pubic lice are transmitted by sexual contact. Symptoms, signs,
diagnosis, and treatment differ by location of infestation. ...
Section/Chapter: Details
Head lice
Head lice are most common among girls aged 5 to 11 but can affect almost anyone;
infestations are rare in blacks. Head lice are easily transmitted from person to
person with close contact (as occurs within households and classrooms) and may be
ejected from hair by static electricity or wind;...
Body lice
Body lice primarily live on bedding and clothing, not people, and are most
frequently found in cramped, crowded conditions (eg, military barracks) and in
people of low socioeconomic status. Transmission is by sharing of contaminated
clothing and bedding. Body lice are main vectors of epidemic...
Pubic lice
Pubic lice (crabs) are sexually transmitted in adolescents and adults and may be
transmitted to children by close parental contact. They may also be transmitted by
fomites (eg, towels, bedding, clothing). They most commonly infest pubic and
perianal hairs but may spread to thighs, trunk, and...
Key Points
Head and pubic lice live on people, whereas body lice live in garments. Confirm the
diagnosis of lice by finding live lice or live nits. Treat head or pubic lice with a topical
drug (eg, a pyrethroid) or oral ivermectin. Treat body lice symptomatically and by
eliminating the source of lice.

Head lice
Head lice infest the hair and scalp. The infestation is spread by close personal
contact and possibly by shared combs, brushes, hats, and other personal items.
Static electricity or wind may eject lice from hair. Head lice are most common
among girls aged 5 to 11 but can affect almost anyone. Head lice are rare in blacks.
There is no association between head lice and poor hygiene or low socioeconomic
status.

Head Lice
Body lice
Body lice usually infest people who have poor hygiene, people who are living in
cramped, crowded conditions (such as military barracks), and people who are of low
socioeconomic status. They live on clothing and bedding that are in contact with the

skin, not on people. Body lice are spread by sharing contaminated clothing and
bedding. Unlike head lice, body lice sometimes transmit serious diseases such as
typhus, trench fever, and relapsing fever.
Pubic lice
Pubic lice (crabs), which primarily infest the hairs in the genital and anal areas,
are typically spread among adolescents and adults by sexual contact. They may be
transmitted to children by close contact with parents. Pubic lice may also be
transmitted by inanimate objects, such as towels, bedding, and clothing. These lice
may infest the chest, thigh, and facial (beard, mustache, and eyelashes) hair as
well.

Pubic Lice (Eyelashes)

Symptoms
Lice infestation usually causes severe itching in the infested area.
Body lice bites cause small, red, pinpoint holes in the skin. People have scratch
marks, hives, or, if intense scratching has broken the skin, a bacterial infection.
These symptoms are especially common on the shoulders, buttocks, and abdomen.

Pubic lice bites may also cause bluish gray spots to form on the chest, buttocks, and
thighs. Lymph nodes can swell. Lice that have infested the eyelashes cause eye
itching, burning, and irritation.
Children may hardly notice head lice or may have only a vague scalp irritation.
Diagnosis
Head lice can be found by moving a fine-tooth comb through wet hair from the scalp
outward. Lice are usually found at the back of the head or behind the ears. Lice
themselves are sometimes hard to find, but their eggs are easier to see. Female lice
lay shiny grayish white eggs (nits) that can be seen as tiny globules firmly stuck to
the base of hair shafts. Each adult female louse lays 3 to 5 eggs per day, so nits
typically greatly outnumber lice. With chronic scalp infestations, the nits grow out
with the hair and therefore can be found some distance from the scalp, depending
on the duration of the infestation.
Nits are distinguished from other foreign material present on hair shafts by the fact
that they are so strongly attached. Adult body lice and their eggs also may be found
in the seams of clothing and bedding. Pubic lice can be found by close inspection
with an ultraviolet light or by analyzing them with a microscope. Pubic lice may also
leave dark brown specks (feces) on the skin or undergarments.
Treatment
Head lice
Several effective prescription and nonprescription drugs are available to treat head
lice. Nonprescription shampoos and creams containing pyrethrins plus piperonyl
butoxide are applied for 10 minutes and are then rinsed out. Prescription permethrin
(a synthetic form of pyrethrin), applied as a liquid or as a cream, is also effective.
Lindanea prescription drug that can be applied as a lotion or shampooalso cures
lice infestation but is not as effective as the other preparations and is not
recommended for children under age 2, pregnant or lactating women, or people
with a seizure disorder because of possible toxic side effects. Prescription malathion
is highly effective at killing both adult lice and eggs, but it is not the first treatment
doctors give because it is flammable, has an unpleasant odor, and must remain on
the person for 8 to 12 hours. All of these louse treatments are repeated in 7 to 10
days to kill newly hatched lice. Lice have started to become resistant to drugs and
may be hard to kill. One dose of the drug ivermectin is usually given by mouth if lice
resist standard treatment.
Most drug treatments also kill nits but do not remove them. Dead nits do not have
to be removed, but drugs do not always kill all nits. Because it is not usually
possible to distinguish between living and dead nits, doctors recommend removing
them. In addition, a very small percentage of children with nits in their scalp still
have live lice. Removal requires a fine-tooth combwhich is often packaged with
the lice removal productsand careful searching (hence the term nit-picking).
Because the nits are so strongly stuck to the hair, several nonprescription
preparations (shampoos, gels, and sprays) are available to loosen them. Thirty

minutes under a hot hair dryer may also help kill nits (but not lice). Nits are carried
away from the scalp as the hair grows. If there are no nits within inch of the scalp,
the person does not have any live lice. For head lice, doctors do not have good
evidence that it is necessary to clean or throw away peoples personal items or to
exclude people from school or work. However, many experts recommend that
clothing and bedding that is contaminated with the nits of lice be replaced or
decontaminated by thorough laundering or dry cleaning. These items should
probably be dried in a drying machine that reaches 130 F for about 30 minutes.
Pubic lice
Pubic lice can be treated with nonprescription shampoos and creams containing
pyrethrins plus piperonyl butoxide or lindane, as head lice are treated. Sex partners
should also be treated. Lice that affect the eyelashes can be treated with petroleum
jelly applied for 8 to 10 days, fluorescein eye drops, ivermectin taken by mouth,
petrolatum salve, physostigmine ointment, or careful removal of each louse with an
instrument.

Pubic Lice
Body lice
Usually, no drug is used to eliminate body lice because body lice are in clothing and
linens and not the person. Doctors treat a person's symptoms and recommend
replacing or decontaminating affected clothing and linens by thorough laundering or
dry cleaning. It is best to expose these items to heat of at least 149 F during
drying.