A Diagnosis of Pediculosis Pubis Should Initiate A Search for Other Sexually Transmitted Disease

Abstract

Background Pediculosis pubis is caused by infestation of the body with Phthirus pubis, the crab louse or pubic lice. P. pubis belongs to the phylum Arthropoda, the class Insecta and the order Phthiraptera. Adult pubic lice are typically 1-2 mm in size and wingless with a broad, flat translucent body through which freshly ingested blood may be observed. The body is crab-like and divided into the head, thorax and abdomen, with three pairs of short, stout legs and powerful claws, which enable them to grasp hair shafts tightly. The disease can be sexually transmitted. Although it is considered sexually transmitted disease, transmission has been documented to occur from contaminated clothing, towels, and bedding. This parasite has a lifespan of less than 3 weeks during which time the female will lay about 25 eggs on human hairs. The adult crab louse can survive for 36 hours off the human host, while the eggs are viable for up to 10 days. The infestation affects 1-2% of the human population worldwide and is generally associated with poor hygiene and overcrowding. P. pubis found in the pubic region, infests the terminal hairs of the pubic and perianal areas, as well as hairy areas of the legs, abdomen, chest, axillae, and arms may also infest the eyelashes and scalp. Eggs at hair skin junction indicate active infestation. Patients main complain is of itch in the pubic area but often asymptomatic. Skin lesions may appear papular urticaria (small erythematous papules) at sites of feeding, especially periumbilica. Although rare, skin lesions named maculae caerulea, representing hemorrhage, can be seen with pubic lice with slate gray to bluish, irregular shaped macules about 1 cm in diameter. A diagnosis of pediculosis pubis should initiate a search for other sexually transmitted disease (STDs), including HIV infection. These lice can be mistaken for scabs or moles, or can blend in with skin color making them difficult to detect. Infested patients have an average of 10-25 adult organisms on their body. Nits can also be identified near the base of hairs. Therefore, the diagnosis can be confirmed by microscopic examination of the plucked hair to identify the nits and/or adult lice. Infestation of pediculosis pubis was the most common followed by fungal sexual transmitted infection (STI), candidal balanoposthitis. Treatment of pediculosis pubis is similar to that for head lice. First line therapy consists of permethrin or pyrethrins with piperonyl butoxide. Second line therapy contains phenothrin, malathion and oral ivermectin. For eyelash involvement, a thick coating of petrolatum can be applied twice daily for 8 days, followed by mechanical removal of any remaining nits. Fluorescein and 4% pilocarpine gel are also effective. Clothing and fomites should be washed and dried by machine, or laundered and ironed. The infested patient and their sexual's contact should avoid close contact and sexual contact. Partner management for pediculosis pubis is required with a look-back period of time of 3 months. The disease is not prevented by condom use. Though the use of barrier contraceptive method would be more in the present era compared to a decade ago, barrier method of contraception may not prevent transmission of pediculosis pubis. This could be one of the causes of higher occurrence of these STI. Retreatment may be necessary if lice are found or if eggs are observed at the hair-skin junction.

Full text

A Diagnosis of Pediculosis Pubis Should Initiate A Search for Other
Sexually Transmitted Disease
1Anita Widaad Taqiyyah and 2 Yudha Nurdian
1Student, Faculty of Medicine, University of Jember, Indonesia.
2Facullty of Medicine, University of Jember, Indonesia.
Corresponding author : Anita Widaad Taqiyyah; anitataqiyyah@gmail.com; 152010101052@students.unej.ac.id
Abstract
Background
Pediculosis pubis is caused by infestation of the body with Phthirus pubis, the crab louse or
pubic lice. P. pubis belongs to the phylum Arthropoda, the class Insecta and the order
Phthiraptera. Adult pubic lice are typically 1-2 mm in size and wingless with a broad, flat
translucent body through which freshly ingested blood may be observed. The body is
crab-like and divided into the head, thorax and abdomen, with three pairs of short, stout legs
and powerful claws, which enable them to grasp hair shafts tightly. The disease can be
sexually transmitted. Although it is considered sexually transmitted disease, transmission has
been documented to occur from contaminated clothing, towels, and bedding. This parasite
has a lifespan of less than 3 weeks during which time the female will lay about 25 eggs on
human hairs. The adult crab louse can survive for 36 hours off the human host, while the eggs
are viable for up to 10 days. The infestation affects 1-2% of the human population worldwide
and is generally associated with poor hygiene and overcrowding. P. pubis found in the pubic
region, infests the terminal hairs of the pubic and perianal areas, as well as hairy areas of the
legs, abdomen, chest, axillae, and arms may also infest the eyelashes and scalp. Eggs at hair
skin junction indicate active infestation. Patients main complain is of itch in the pubic area
but often asymptomatic. Skin lesions may appear papular urticaria (small erythematous
papules) at sites of feeding, especially periumbilica. Although rare, skin lesions named
maculae caerulea, representing hemorrhage, can be seen with pubic lice with slate gray to
bluish, irregular shaped macules about 1 cm in diameter. A diagnosis of pediculosis pubis
should initiate a search for other sexually transmitted disease (STDs), including HIV
infection. These lice can be mistaken for scabs or moles, or can blend in with skin color
making them difficult to detect. Infested patients have an average of 10–25 adult organisms
on their body. Nits can also be identified near the base of hairs. Therefore, the diagnosis can
be confirmed by microscopic examination of the plucked hair to identify the nits and/or adult
lice. Infestation of pediculosis pubis was the most common followed by fungal sexual
transmitted infection (STI), candidal balanoposthitis. Treatment of pediculosis pubis is
similar to that for head lice. First line therapy consists of permethrin or pyrethrins with
piperonyl butoxide. Second line therapy contains phenothrin, malathion and oral ivermectin.
For eyelash involvement, a thick coating of petrolatum can be applied twice daily for 8 days,
followed by mechanical removal of any remaining nits. Fluorescein and 4% pilocarpine gel
are also effective. Clothing and fomites should be washed and dried by machine, or laundered
and ironed. The infested patient and their sexual’s contact should avoid close contact and
sexual contact. Partner management for pediculosis pubis is required with a look-back period
of time of 3 months. The disease is not prevented by condom use. Though the use of barrier
contraceptive method would be more in the present era compared to a decade ago, barrier
method of contraception may not prevent transmission of pediculosis pubis. This could be
one of the causes of higher occurrence of these STI. Retreatment may be necessary if lice are
found or if eggs are observed at the hair-skin junction.

Conclusion
Pediculosis pubis caused by Phthirus pubis is sexually transmitted disease that common
found in HIV patient. Patients main complain is of itch in the pubic area, but often
asymptomatic. The parasite is found in the pubic region, as well as hairy areas of the legs,
abdomen, chest, axillae, and arms may also infest the eyelashes and scalp. First line therapy
consists of permethrin or pyrethrins with piperonyl butoxide. Partner management should be
treatment. The disease is not prevented by condom use.
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