Pubic lice, Phthirus pubis, are small, macroscopic parasites that are generally sexually transmitted, annoying, and medically trivial. Fomites also are known to transmit lice. Also called ''crabs,'' these organisms localize to the pubic hair and eyelashes, and these are distinct from head lice.
The primary symptom of lice is itching. Physical findings are often very, very subtle. The 1 to 2 mm mites are nearly skin colored and attached to hair. Very close examination with magnification generally also reveals nits, light-colored oval eggs glued to the hairs. The skin is usually normal in appearance (Fig. 24). Modified mucous membranes and the vaginal epithelium are not affected.
None, or itching
Small tan para-
sites and nits
The differential diagnosis includes any pruritic disease. The diagnosis is made by the visualization of the mite or nits.
The management of pubic lice includes a screen for other sexually transmitted diseases, as these have been reported to occur more often in patients with pubic lice (66). Treatment consists of the elimination of the lice, destruction of nits, and the treatment of fomites. Lindane applied topically overnight generally kills the lice and the nits, although the nits remain glued to the hair shaft. Alternatively, over-the-counter pyrethrin or permethrin are also effective, but resistance to pyrethrin has been reported (67). The nits can be left in place, removed by shaving the affected hair, or removed with a nit comb, a very fine comb often included with the medication. Resistance of pubic lice, like head lice, is becoming recognized (Table 20).
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