Consequences of Not Treating Pubic Lice

Pubic lice, commonly known as “crabs,” are parasitic insects that infest the coarse hair of the genital area. While they do not transmit diseases, neglecting treatment can lead to significant health issues.

This chart illustrates the psychological effects of untreated pubic lice. Anxiety and sleep disturbance are among the most prevalent issues, followed by depression and social withdrawal. Timely treatment can help mitigate these impacts.

1. Persistent Itching and Discomfort

One of the first and most noticeable symptoms of pubic lice infestation is intense itching. This occurs due to an allergic reaction to lice saliva. Over time, constant itching can cause:

• Skin irritation and inflammation.
• Redness and swelling in the affected area.
• Disruptions in daily life due to discomfort.
• Sleep disturbances caused by excessive nighttime itching.
• Increased stress levels due to persistent irritation.

If untreated, some individuals develop lichenification, a condition where the skin thickens and becomes leathery due to constant scratching. This can make future treatments less effective and cause chronic discomfort. In severe cases, patients may require topical corticosteroids to reduce inflammation.

2. Secondary Skin Infections

Frequent scratching can lead to open sores, increasing the risk of bacterial infections such as:

• Impetigo: A contagious bacterial infection causing crusty sores.
• Cellulitis: A deeper skin infection that can spread and cause pain, swelling, and fever.
• Folliculitis: Infection of the hair follicles, leading to painful red bumps.

Untreated secondary infections may require antibiotic treatment, either topical (such as mupirocin) or oral (like cephalexin). A case study of a 40-year-old man in Florida showed that his untreated pubic lice led to a cellulitis infection requiring hospitalization and IV antibiotics.

3. Transmission to Others

Untreated pubic lice can easily spread through:

• Sexual contact.
• Shared clothing, towels, or bedding.
• Close body contact with infected individuals.

A study found that individuals with untreated lice had a 60% higher chance of passing them to husband or wife than those who sought treatment immediately. The risk is particularly high in shared living environments, such as college dormitories or hostels.

4. Psychological and Emotional Distress

Long-term infestations can impact mental well-being, leading to:

• Anxiety and embarrassment.
• Sleep disturbances due to excessive itching.
• Lowered self-esteem and strained relationships.
• Paranoia about reinfestation and cleanliness.

Psychological distress is often underestimated, but studies show that 30% of individuals with chronic parasitic infestations develop anxiety or depression due to the social stigma associated with the condition.

5. Eyelash and Eyebrow Infestation

Although pubic lice primarily affect the genital area, they can spread to other coarse hair regions, including:

• Eyelashes (Phthiriasis palpebrarum): Leading to eye irritation, redness, and even conjunctivitis.
• Eyebrows and armpits: Causing further discomfort and increasing the spread of lice.

Treating lice in the eyelashes is more challenging, as standard lice shampoos cannot be used near the eyes. Doctors may prescribe petrolatum ointment (Vaseline) applied nightly for 10 days or specialized ophthalmic treatments.

6. Increased Risk of STIs Due to Scratching

Although pubic lice do not transmit sexually transmitted infections (STIs), excessive scratching can create open wounds, making it easier for STIs to enter the body. This is particularly concerning for individuals already at risk. Studies indicate that individuals with untreated pubic lice are twice as likely to acquire bacterial STIs due to skin abrasions and inflammation.

A case report from New York documented a woman who developed herpes simplex virus (HSV-2) in the affected area after prolonged scratching, making her recovery more painful and prolonged.

7. Social Stigma and Relationship Issues

Having pubic lice can cause social embarrassment, leading to:

• Relationship stress due to fear of transmission.
• Avoidance of intimacy.
• Misconceptions about hygiene (even though lice infestations are not related to cleanliness).
• Isolation due to self-consciousness about symptoms.

A survey of individuals who had pubic lice found that 40% avoided dating or intimacy between husband and wife for more than three months due to stigma, impacting their social and emotional well-being.

Common Symptoms and Their Frequency

This chart presents the common symptoms of pubic lice and their frequency. Itching and redness are the most prevalent, while more severe effects, such as secondary infections and eye irritation, occur less frequently.

How to Treat and Prevent Pubic Lice

Ignoring an infestation is not a solution. Effective treatments include:

1. Over-the-Counter Treatments

• Medications Used: Permethrin-based creams (1%) and shampoos.
• Application Process: Apply the product to the affected area, leave it on for 10 minutes, then rinse thoroughly.
• Effectiveness: 85–90% effective when used correctly.
• Reliability: Most cases resolve with a single treatment, though a second application may be necessary after 7–10 days.
• Case Example: A 28-year-old male from California successfully eliminated pubic lice with permethrin lotion but required a second application due to reinfestation from unwashed bedding.

2. Prescription Medications

• Medications Used: Ivermectin (oral medication, 200 mcg/kg) or Malathion lotion (0.5%).
• Application Process: Ivermectin is taken as two doses, 7 days apart. Malathion lotion is applied for 8–12 hours before washing off.
• Effectiveness: Ivermectin is over 95% effective; Malathion has similar success rates.
• Reliability: More effective in cases where lice show resistance to permethrin.
• Case Example: A 35-year-old woman from Texas, who had persistent lice after using OTC treatments, successfully eradicated them with Ivermectin.

3. Laundering Clothing and Bedding

• Process: Wash all clothing, bedding, and towels in hot water (at least 130°F) and dry on high heat.
• Effectiveness: 100% effective in eliminating lice and nits from fabrics.
• Reliability: Essential for preventing reinfestation.
• Case Example: A family in New York had recurrent cases of pubic lice until they implemented thorough laundering practices.

4. Avoiding Close Contact

• Process: Abstain from intimate contact and avoid sharing personal items until treatment is complete.
• Effectiveness: Prevents further transmission.
• Reliability: Highly effective when combined with medical treatment.
• Case Example: A 22-year-old college student from Florida prevented reinfection by informing husband or wife and avoiding contact until cleared.

This chart demonstrates the effectiveness of treatment at different time intervals. Immediate treatment offers the highest cure rate, while delays significantly reduce effectiveness.

Editorial Advice

Reyus Mammadli, healthcare advisor, strongly advises against delaying treatment for pubic lice. “Ignoring pubic lice won’t make them disappear. The longer you wait, the worse the symptoms become, leading to infections and unnecessary distress. Quick action is key.”

If you suspect an infestation, seek medical advice and follow proper treatment protocols. Keeping personal hygiene items separate and regularly checking for signs of lice can help prevent reinfestation.

References

1. Centers for Disease Control and Prevention (CDC). “Parasites – Pubic Lice (Pthiriasis).” www.cdc.gov
2. Mayo Clinic. “Pubic Lice (Crabs) – Symptoms and Causes.” www.mayoclinic.org
3. American Academy of Dermatology Association (AAD). “How to Treat Pubic Lice.” www.aad.org
4. National Library of Medicine (NIH). “Epidemiology and Treatment of Pubic Lice Infestation.” www.ncbi.nlm.nih.gov
5. World Health Organization (WHO). “Parasitic Infestations and Public Health Risks.” www.who.int
6. Clinical studies on permethrin and ivermectin for pubic lice treatment, Journal of Infectious Diseases.
7. Case reports and studies from U.S. dermatology clinics on pubic lice complications and treatments.