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| {{About|the disease|the animal known as crab louse|Crab louse}}
| | #REDIRECT[[Pubic louse infestation]] |
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| {{Infobox disease
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| |Name = Pediculosis pubis
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| |Image = SOA-Pediculosis-pubis.jpg
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| |Caption = Pubic lice in genital area
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| | ICD10 = {{ICD10|B|85|3|b|85}}
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| | ICD9 = {{ICD9|132.2}}
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| | ICDO =
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| | OMIM =
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| | DiseasesDB = 10028
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| | MedlinePlus = 000841
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| | eMedicineSubj = med
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| | eMedicineTopic = 1769
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| | MeshID = D010373
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| }}
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| __NOTOC__
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| {{CMG}}; {{AE}} {{KS}}
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| {{SK}} Pubic louse infestation; Phthiriasis pubis
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| [[File:Fig. 2. Pubic lice in abdomen.jpg|thumb|Pubic lice on the abdomen]]
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| ==Overview==
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| '''Pediculosis pubis''' (also known as "'''crabs'''" and "'''pubic lice'''"<ref name="Bolognia">{{cite book |author=Ronald P. Rapini, Jean L. Bolognia & Joseph L. Jorizzo |title=Dermatology |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0}}</ref>) is a disease caused by the [[pubic louse]], ''Pthirus pubis'', a [[parasitism|parasitic]] [[insect]] notorious for infesting human [[pubic hair]]. The species may also live on other areas with hair, including the [[eyelash]]es, causing pediculosis ciliaris. Infestation usually leads to intense itching in the pubic area. Treatment with topic agents such as [[permethrin]] or [[pyrethrin]] with [[piperonyl butoxide]] is exceedingly effective. Worldwide it affects about 2% of the population.
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| ==Classification==
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| Infestation with pubic lice is also called phthiriasis or phthiriasis pubis, while infestation of eyelashes with pubic lice is called phthiriasis palpebrarum or pediculosis ciliarum.<ref>{{cite journal |author=N. P. Manjunatha, G. R. Jayamanne, S. P. Desai, T. R. Moss, J. Lalik & A. Woodland |year=2006 |title=Pediculosis pubis: presentation to ophthalmologist as pthriasis palpebrarum associated with corneal epithelial keratitis |journal=[[International Journal of STD & AIDS]] |volume=17 |issue=6 |pages=424–426 |doi=10.1258/095646206777323445}}</ref> The disease is spelled with ''phth'', even though the scientific name of the louse is spelled with ''pth''.
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| ==Epidemiology==
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| Current worldwide prevalence has been very approximately estimated at two percent of the human population. Accurate numbers are difficult to acquire, because pubic lice infestations are not considered a reportable condition by many governments, and many cases are self-treated or treated discreetly by personal physicians.<ref>{{cite journal |author=Alice L. Anderson & Elizabeth Chaney |year=2009 |title=Pubic lice (''Pthirus pubis''): history, biology and treatment vs. knowledge and beliefs of US College students |journal=[[International Journal of Environmental Research and Public Health]] |volume=6 |issue=2 |pages=592–600 |pmid=19440402 |pmc=2672365 |doi=10.3390/ijerph6020592 |url=http://www.mdpi.com/1660-4601/6/2/592}}</ref>
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| Although any part of the body may be colonized, crab lice favor the hairs of the genital and peri-anal region. Especially in male patients, pubic lice and eggs can also be found in hair on the abdomen and under the armpits, as well as on the beard and mustache, while in children they are usually found in eyelashes.
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| It has recently been suggested that an increasing percentage of humans [[Body grooming|removing]] their [[pubic hair]] has led to reduced crab louse populations in some parts of the world.<ref>{{cite journal |author=N. R. Armstrong & J. D. Wilson |year=2006 |title=Did the "Brazilian" kill the pubic louse? |journal=[[Sexually Transmitted Infections (journal)|Sexually Transmitted Infections]] |volume=82 |pages=265–266 |doi=10.1136/sti.2005.018671 |pmid=16731684 |pmc=2564756}}</ref><ref>Bloomberg: [http://www.bloomberg.com/news/2013-01-13/brazilian-bikini-waxes-make-crab-lice-endangered-species-health.html Brazilian bikini waxes make crab lice endangered species], published 13 January 2013, retrieved 14 January 2013</ref>
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| ===In animals===
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| [[Human]]s are the only known hosts of this parasite, although a closely related species, ''[[Pthirus gorillae]]'', infects [[gorilla]] populations.<ref>{{cite journal |author=Robin A. Weiss |year=2009 |title=Apes, lice and prehistory |journal=[[Journal of Biology]] |volume=8 |issue=2 |page=20 |pmid=19232074 |pmc=2687769 |doi=10.1186/jbiol114}}</ref>
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| ==Signs and symptoms==
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| The main symptom is [[itch]]ing, usually in the pubic-hair area, resulting from [[hypersensitivity]] to louse saliva, which can become stronger over two or more weeks following initial infestation.<ref name=Review07/> In some infestations, a characteristic grey-blue or slate coloration [[macule]] appears (''maculae caeruleae'') at the feeding site, which may last for days.<ref name=Review07/> Nits or live lice may also be visible to the unaided eye.<ref name=Review07/>
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| <ref name="test">{{cite book |author=John O'Donel Alexander |year=1984 |title=Arthropods and Human Skin |publisher=[[Springer Science+Business Media|Springer]] |location=Berlin |isbn=978-1-4471-1358-4 |url=http://link.springer.com/book/10.1007/978-1-4471-1356-0/page/1}}</ref>
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| ==Parasitology==
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| {{Main|Crab louse}}
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| ===Characteristics===
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| Pubic lice are between 1 and 3 mm long with 6 legs.<ref name=Review07>{{cite journal |author=P. A. Leone |title=Scabies and pediculosis pubis: an update of treatment regimens and general review |journal=[[Clinical Infectious Diseases]] |volume=44 |issue=Suppl. 3 |pages=S153–S159 |year=2007 |pmid=17342668 |doi=10.1086/511428}}</ref>
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| ===Transmission===
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| Pubic lice are usually acquired by intimate contact between individuals.<ref name=Review07/> Parent-to-child infestations are more likely to occur through routes of shared towels, clothing, beds or closets. Adults are more frequently infested than children. As with most sexually transmitted pathogens, they can only survive a short time away from the warmth and humidity of the human body.
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| Infection in a young child or teenager is not necessarily indicative of sexual abuse, although this possibility should be kept in mind.<ref>{{cite journal |author=Sidney Klaus, Yigal Shvil & Kosta Y. Mumcuoglu |title=Generalized infestation of a 3½-year-old girl with the pubic louse |journal=[[Pediatric Dermatology]] |volume=11 |issue=1 |pages=26–28 |year=1994 |pmid=8170844 |doi=10.1111/j.1525-1470.1994.tb00068.x}}</ref><ref>{{cite journal |author=José A. Varela, Luis Otero, Emma Espinosa, Carmen Sánchez, María Luisa Junquera & Fernando Vázquez |title=''Phthirus pubis'' in a sexually transmitted diseases unit: a study of 14 years |journal=[[Sexually Transmitted Diseases (journal)|Sexually Transmitted Diseases]] |volume=30 |issue=4 |pages=292–6 |date=April 2003 |pmid=12671547|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0148-5717&volume=30&issue=4&spage=292|doi=10.1097/00007435-200304000-00004}}</ref>
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| ==Diagnosis==
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| A pubic louse infestation is usually diagnosed by carefully examining pubic hair for [[Louse#Biology|nit]]s, [[nymph (biology)|nymphs]], and adult lice.<ref name=Review07/> Lice and nits can be removed either with forceps or by cutting the infested hair with scissors (with the exception of an infestation of the eye area). A magnifying glass or a [[stereo-microscope]] can be used for the exact identification. If lice are detected in one family member, the entire family needs to be checked and only those who are infested with living lice should be treated.
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| ===Physical Examination===
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| ====Genitalia====
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| <gallery>
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| Image:Pediculosis pubis01.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis02.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis03.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis04.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis05.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis06.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis07.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis08.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis09.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis10.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis11.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis12.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis13.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis14.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis15.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis16.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis17.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis18.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis19.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis20.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis23.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis24.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis21.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis22.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis23.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis25.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis26.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| Image:Pediculosis pubis27.jpg|Pediculosis pubis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
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| </gallery>
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| Testing for other [[sexually transmitted infections]] is recommended in those who are affected.<ref name=Review07/>
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| ==Treatment==
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| Permethrin 1% cream rinse and pyrethrins can be used for this purpose and are the drugs of choice for pregnant or lactating women. These agents should be applied to the affected areas and washed off after 10 minutes. Resistance of pubic lice to pyrethroids must be if at all very rare. A second treatment after 10 days is recommended.
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| Pubic lice on the eyelashes can be treated with a permethrin formulation by applying the solution to the infested hair with an applicator. It is dangerous to remove lice or eggs in the eyelashes with forceps or scissors. | |
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| Lindane shampoo (1%), a pediculocide, is FDA approved as safe and effective when used as directed for the second-line treatment of pubic lice (crabs).While serious side effects have been reported, they are considered to be rare and have almost always resulted from misuse of medication, such as excessive application and oral ingestion. To minimize this risk, Lindane medications are now dispensed in small single-use bottles. <ref name="CDC"> Lindane shampoo, USP, 1% prescribing information. Updated March 28, 2003. http://www.fda.gov/cder/foi/label/2003/006309shampoolbl</ref> <ref> U.S. Food and Drug Administration (FDA). Lindane Post Marketing Safety Review. Posted 2003. Available at: http://www.fda.gov/cder/drug/infopage/lindane/lindaneaeredacted.pdf.</ref> The Centers for Disease Control and Prevention (CDC) notes that lindane should not be used immediately after a bath or shower, and it should not be used by persons who have extensive dermatitis, women who are pregnant or lactating or children aged <2 years. <ref>U.S. Centers for Disease Control and Prevention (CDC). Ectoparasitic infections. Sexually transmitted diseases treatment guidelines. 2006. MMWR Recomm Rep. 2006, August 10;55 (No. RR-11):79-80.</ref> The FDA similarly warns against use in patients with a history of uncontrolled seizures disorders and premature infants, and recommends cautious use in infants, children, the elderly, and individuals with other skin conditions (e.g., atopic dermatitis, psoriasis) and in those who weigh less than 110 lbs (50 kg). <ref name="CDC"> </ref>
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| * '''Phthirus pubis treatment'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
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| :* Preferred regimen (1): [[Permethrin]] 1% cream rinse applied to affected areas and washed off after 10 minutes
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| :* Preferred regimen (2): Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes
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| :* Alternative regimen (1): [[Malathion]] 0.5% lotion applied to affected areas and washed off after 8–12 hours
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| :* Alternative regimen (2): [[Ivermectin]] 250 ug/kg PO, repeated in 2 weeks
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| Pubic lice are primarily spread through sexual intercourse. Therefore, all partners with whom the patient has had sexual contact within the previous 30 days should be evaluated and treated, and sexual contact should be avoided until all partners have successfully completed treatment and are thought to be cured. Because of the strong association between the presence of pubic lice and classic sexually transmitted infections ([[sexually transmitted infections|STI]]s), patients diagnosed with pubic lice should undergo evaluation for other STIs.
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| ===Pediculosis ciliaris===
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| Infections of the eyelashes may be treated with either [[petroleum jelly]] applied twice daily for 10 days or [[malathion]], [[phenothrin]] and [[carbaryl]].<ref name=Review07/>
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| ==References==
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| {{reflist|32em}}
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| ==External links==
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| {{Commons category|Pubic lice}}
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| *[http://entomology.ifas.ufl.edu/creatures/urban/crab_louse.htm Crab louse] on the [[University of Florida|UF]] / [[Institute of Food and Agricultural Sciences|IFAS]] Featured Creatures Web site
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| *[http://www.bashh.org/guidelines/2002/pubic_lice_0901b.pdf Edinburgh Royal Infirmary on Pubic Lice]
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| *[http://www.nlm.nih.gov/medlineplus/ency/article/000841.htm Medline Plus article]
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| *[http://www.bashh.org/guidelines/2007/management_of_phthirus_pubis_infestation.pdf Guideline on the Management of ''Phthirus pubis'' infestation (UK, 2007)]
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| *[http://www.plosbiology.org/plosonline/?request=get-document&doi=10.1371/journal.pbio.0020340 Genetic Analysis of Lice Supports Direct Contact Between Modern and Archaic Humans]
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| {{STD/STI}}
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| {{Human lice}}
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| {{Arthropod infestations}}
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| [[Category:Lice]]
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| [[Category:Sexually transmitted diseases and infections]]
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| [[Category:Parasitic infestations, stings, and bites of the skin]]
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