Pubic Lice ("Crabs"): What to Know

Intense itching in the pubic area, worse at night, is the most common and recognizable symptom. You might also notice small blue-gray spots on the skin (from lice bites), tiny white specks attached to hair (their eggs, called nits), or, in some cases, the lice themselves, visible as small, pale insects near the base of pubic hair.

Close physical contact, most often sexual, is the primary transmission route, since the lice need to crawl from one person's hair to another's rather than jumping or flying. Sharing bedding, towels, or clothing shortly after contact with an infested person carries a smaller but real additional risk, since lice can survive briefly away from a host.

Over-the-counter permethrin-based treatments (the same active ingredient used for head lice) are typically effective, applied according to the product instructions and often repeated after about a week to catch any newly hatched lice. Washing bedding, towels, and recently worn clothing in hot water helps prevent reinfestation. Sexual partners from the past month should be informed and treated as well, since re-exposure is otherwise likely.