For most pubic lice infestations, treatment involves using special lotions or shampoos that kill the lice (a pediculicide).

Lice-killing shampoos and lotions that contain 1 percent of the active ingredient permethrin or pyrethrin are available over the counter. They are usually applied to all affected areas (excluding the eyes), left on for a few minutes to a few hours and then rinsed off. All lotions or shampoos should be applied and rinsed off according to the manufacturer’s directions, because treatment times will vary depending on the product. Prescription strength lice-killing lotion may also be available.

Lotions or shampoos containing the ingredient lindane are no longer recommended because of the risk of serious side effects such as seizures and, in rare cases, death. Patients should consult their physician about their risks before using any product with lindane.

Special lotions or shampoos do not kill pubic lice eggs (nits), which may still be attached to hair shafts. Nits can be removed with the fingernails, tweezers or by using a specially designed fine-toothed comb called a nit comb. Using such a comb rids the area of dead pubic lice as well. Occasionally, some pubic lice may survive treatment and need to be combed out. Any live lice can be placed in a drop of the medicated lotion or shampoo to kill it.

Removing pubic lice and nits using only a nit comb (without prior use of a medicated lotion or shampoo) may also work as a treatment, although it is considerably more time-consuming. This may be helpful when just a few pubic lice or nits are found, or when they are found in the eyebrow or eyelash area. Shaving all hair from the affected area may rid the area of pubic lice, but is often not necessary. Shaving should not be done in certain areas (e.g., around the eyes).

A single treatment may not rid the area of all pubic lice. Multiple treatments may be required, often administered a week apart. This can help ensure any nits that survived the initial treatment have not hatched lice since treatment was applied. In addition, certain types of medications may sometimes fail to treat a pubic lice infestation due to increasing incidents of drug resistance.

Certain oral medications may also be available by prescription. This may be particularly helpful for people with pubic lice on the eyelashes or in cases where pubic lice are near the rectum. However, these systemic medications are not recommended for pregnant or breastfeeding women or children weighing 33 pounds (15 kilograms) or less. For infestation of the eyelids, a special petroleum ointment may be available by prescription. Over-the-counter petroleum gels should not be used.

Clean underwear and clothing should be put on after treatment. Personal items should be cleaned if they have been recently handled (within a day or two of treatment) by a person infested with pubic lice. In order to kill lice and nits in bedding, clothing and towels, these items should be washed in hot water – at least 130 degrees Fahrenheit (54 degrees Celsius) – and dried on the hot dryer cycle for at least 20 minutes. Items that are not washable should be dry cleaned, or may be kept sealed in an airtight bag for two weeks. Carpeted areas should be vacuumed.

Sexual activity should be avoided until treatment of all infected persons is completed. Also, it is important to treat all sexual partners of an infested person at the same time, to prevent reinfestation.