Makindo Medical Notes

Shaving the pubic area is not necessary. In the general population, it is reported that the incidence of pubic lice is decreasing with the increase in pubic hair removal due to the destruction of the natural habitat of the parasite.

About

• Pubic lice infestation may be associated with other STDs, and screening for additional infections is recommended.

Aetiology

• Caused by Phthirus pubis, spread primarily through intimate skin-to-skin contact.
• Partner management should consider a look-back period of 3 months for potential spread of infestation.

Clinical Features

• Blue Macules: Blue-grey macules, also called maculae ceruleae, can be observed in the pubic area, indicative of lice bites.
• Itching and irritation in the affected area are common symptoms.

Investigations

• Clinical Diagnosis: Diagnosis is typically made through visual inspection for live lice or nits (lice eggs) on the hair and skin.

Management

• Topical Treatment: Apply treatment to all potentially infested regions (genital and anal areas, thighs, trunk, axillae, moustache, and beard areas). Ensure skin is cool and dry to minimize absorption. Reapply treatment after 7-10 days, as recommended.
• Removal of Nits: Use a fine-toothed comb or tweezers to manually remove nits from the hair shafts.
• Laundry and Cleaning: Wash clothing, bedding, and towels in hot water (50°C or higher) or dry-clean, or seal in a plastic bag for 3 days to kill lice. Wear clean underwear and clothing after starting treatment.
• Follow-Up: Re-examine the patient one week after treatment to confirm eradication. Consider the infestation cleared if no live lice are present.

First Line Therapy

• Permethrin 1% Cream: Apply and wash off after 10 minutes. Repeat application after 7-10 days.
• Pyrethrins with Piperonyl Butoxide: Apply and wash off after 10 minutes. Repeat after 7-10 days.

Second Line Therapy

• Phenothrin 0.2% Lotion: Apply and wash off after 2 hours.
• Malathion 0.5% Lotion: Apply and wash off after 12 hours.
• Ivermectin (Oral): Dose of 200 mcg/kg, repeat after 7 days (in severe cases, 400 mcg/kg, repeat after 7 days).

References

• European Guideline for the Management of Pediculosis Pubis