Itching Below the Belt? It Might Be Crabs. Here’s Why You Shouldn’t Ignore It

If you’ve been feeling unusually itchy around your genitals, especially at night, you might be dealing with more than a rash. Pubic lice, better known as crabs, are tiny parasitic insects that make themselves at home in the coarse hairs of the pubic region. While they are less talked about than other sexually transmitted infections (STIs), they still exist and can be found in Singapore.

Crabs are not as dangerous as infections like HIV or syphilis, but they are uncomfortable, highly contagious, and can lead to skin infections if left untreated. They may also cause significant stress and embarrassment. The good news is that they are easy to treat and do not cause long-term health problems.

In this article, you will learn everything you need to know about crabs: what they are, how they spread, how to recognise the symptoms, and how to get rid of them. Most importantly, you will also find out where to go for STD testing in Singapore with Shim Clinic if you think you may have been exposed.

What Are Crabs, Really? Understanding Pubic Lice

Pubic lice, or Pthirus pubis, are small parasitic insects that live on human hair. They are most commonly found in the pubic region, although they can also infest other coarse body hair such as the armpits, chest, thighs, and even eyelashes. These insects are not the same as head lice or body lice. They belong to a different species and have distinct characteristics, including large claws that resemble those of a crab.

Crabs feed on human blood and lay their eggs, called nits, at the base of hair shafts. The eggs hatch in about six to ten days. If not treated, the infestation can persist and spread through close physical contact.

Contrary to common myths, pubic lice are not caused by poor hygiene. They can affect anyone, regardless of how clean they are. In fact, research suggests that Pthirus pubis has been associated with humans for thousands of years. According to a study from the University of Florida’s Natural History Museum, pubic lice likely jumped from gorillas to early humans around 3.3 million years ago, possibly through close contact with nests or carcasses (source).

Archaeological findings also support their long history in human populations. Pubic lice specimens have been discovered in the UK dating as far back as the 1st century AD, demonstrating that these parasites have been part of human life for centuries (source).

Although reported cases have declined in some countries due to grooming trends such as pubic hair removal, pubic lice remain a relevant concern in sexual health. They continue to appear in STD clinics and can be transmitted during intimate contact, making it important to include them in broader conversations around STD symptoms and safe sex practices.

How Do You Get Crabs? Common Modes of Transmission

Pubic lice are most often transmitted through close physical contact, especially sexual activity. They move from one person’s body hair to another’s, usually during intimate skin-to-skin contact. Because they cannot jump or fly, they rely on direct transfer through touch.

While sex is the most common route of transmission for crabs, it’s also possible—though less likely—to get crabs by sharing items like towels, bedding, clothing, or upholstered furniture with someone who is infested. In crowded living environments, such as hostels or dormitories, the risk of indirect transmission may increase if proper hygiene practices are not followed.

It’s important to understand that getting crabs is not a reflection of personal hygiene. Even people who shower regularly and keep their genital area clean can become infested if they come into contact with lice or their eggs. What matters is exposure to an infested individual or contaminated item, not cleanliness.

Because crabs cling tightly to coarse hair, they are most often found in the pubic region. However, they can also survive in other areas with similar hair types, such as the beard, armpits, or even eyelashes. This makes any intimate or prolonged close contact a potential risk.

If you think you may have been exposed to pubic lice, it is important to monitor for symptoms and consider visiting a STD clinic for evaluation. You can learn more about confidential and professional STD testing in Singapore at Shim Clinic.

Itchy in All the Wrong Places: Symptoms to Watch Out For

Pubic lice cause a number of noticeable symptoms, most of which affect the genital region. Here’s what to look out for:

• Intense itching in the pubic area
  This is the most common symptom. The itching is usually worse at night, as the lice become more active.

• Red bumps or blue spots on the skin
  These are caused by lice bites. They may look like mosquito bites but usually appear in clusters around the groin, thighs, or lower abdomen.

• Visible lice or eggs (nits)
  Adult lice are tiny but may be seen with the naked eye, especially with good lighting. Nits are small white or yellowish ovals stuck to the base of hair shafts.

• Small spots of blood or dark powder in underwear
  This may be dried blood or lice droppings.

• Skin irritation or inflammation
  Persistent scratching can break the skin and lead to bacterial infections or sores.

• Mild fever or feeling unwell (less common)
  Some people may feel slightly feverish or irritable due to the irritation and lack of sleep.

• Differences in symptoms between men and women

  • Men may notice symptoms earlier, as coarse pubic hair makes lice more visible.

  • Women may have subtler signs, especially if they shave or wax, which can delay detection.

If you notice any of these symptoms, especially after recent intimate contact, it’s important to get checked. Crabs don’t go away on their own. You can arrange STD testing in Singapore through Shim Clinic.

Diagnosing Crabs: How It’s Done in Singapore

If you suspect you have pubic lice, getting a proper diagnosis is the first step to effective treatment. Here’s what typically happens during a medical consultation:

• Clinical examination
  A doctor will visually inspect the affected areas, especially the pubic region, under good lighting. In most cases, lice or their eggs can be seen without special tools.

• Use of a dermoscope or magnifying lens
  If the infestation is mild or not clearly visible, the doctor may use a handheld magnifier to identify lice or nits on hair shafts.

• Assessment of other body areas
  Crabs can also spread to armpits, thighs, chest, beard, and eyelashes. The doctor may check these areas as well.

• Screening for other STDs
  Since pubic lice are sexually transmitted, it’s common for clinics to recommend testing for other STDs at the same time. This helps rule out co-infections such as chlamydia, gonorrhoea, or HIV.

• Private and discreet consultation
  At Shim Clinic, consultations are handled with full confidentiality. No appointment is required. Simply walk in during clinic hours for professional STD testing in Singapore.

• No lab test usually needed
  Diagnosis is typically based on visual confirmation. Lab tests are rarely required unless the case is unusual or complications are suspected.

Early diagnosis makes treatment faster and reduces the risk of spreading lice to others. If you notice itching or visible nits, get tested!

Treatment Options: Getting Rid of Crabs for Good

The good news is that pubic lice are highly treatable with the right medication and a few simple hygiene steps. Most cases can be managed using over-the-counter creams or shampoos that contain permethrin (1%) or pyrethrin. These are applied directly to the affected areas and left on the skin for a prescribed amount of time before being washed off. In more persistent cases, a doctor may prescribe stronger treatments such as malathion lotion (0.5%) or oral ivermectin, which is especially useful for larger infestations or when topical treatments fail.

To ensure the infestation is fully cleared, a second treatment is usually needed seven to ten days after the first. This step is important because lice eggs (nits) may survive the initial application and hatch later.

In addition to medication, it is essential to wash any clothing, towels, or bedding used within the past few days. These items should be machine washed at 50°C or higher and dried on high heat. Items that cannot be washed should be sealed in a plastic bag for at least two weeks to ensure any remaining lice or eggs die off.

During treatment, sexual activity should be avoided until all symptoms have cleared. It is also important to inform and treat any recent sexual partners, even if they do not have symptoms. This helps prevent re-infestation and limits the risk of ongoing transmission.

If symptoms persist after two full treatments, it may be necessary to return to the clinic for reassessment. Some lice may be resistant to standard medications, or the diagnosis may need to be reviewed to rule out other causes of itching.

At Shim Clinic, patients can receive a discreet, walk-in consultation and treatment for pubic lice. The clinic also offers guidance on managing other STDs that may present alongside crabs, ensuring a complete approach to sexual health.

What If You Don’t Treat It? Complications and Co-Infections

Although pubic lice do not cause serious long-term health damage, failing to treat an infestation can result in unnecessary complications. One of the most common issues is secondary skin infection. Repeated scratching of the affected area can break the skin, allowing bacteria to enter and trigger localised infections. These may lead to swelling, redness, or pus-filled sores that require medical attention.

There are also psychological effects to consider. The discomfort and stigma surrounding crabs can lead to anxiety, sleep disturbances, and emotional stress, particularly in situations involving close contact or shared living spaces. Left unaddressed, the problem can continue to affect daily life and intimate relationships.

It is also important to consider that pubic lice may appear alongside other sexually transmitted infections. While crabs themselves do not transmit viruses such as HIV, the presence of lice can indicate unprotected sexual contact, which may place someone at higher risk of other infections.

Many common STDs, including chlamydia, gonorrhoea, and syphilis, can remain unnoticed in the early stages. Timely testing allows for early detection and appropriate treatment, helping to reduce complications and prevent further transmission.

Crabs in the Age of Waxing: Is It Really Going Extinct?

Over the last two decades, health professionals have observed a decline in reported cases of pubic lice in some parts of the world. One proposed reason for this trend is the growing popularity of pubic hair removal, including shaving, waxing, and laser treatments. Since crabs need coarse hair to cling to and lay their eggs, removing that environment makes it harder for them to survive and spread.

A study published in the journal Sexually Transmitted Infections even suggested that the widespread removal of pubic hair might be contributing to the decline of pubic lice infestations. With fewer places for lice to hide and reproduce, the parasite may be losing its foothold in some populations. You can view a summary of that study here: https://pubmed.ncbi.nlm.nih.gov/24825336/

However, it would be premature to assume that pubic lice are no longer a concern. While grooming habits may have changed in some communities, infestations still occur globally, including in Singapore. Not everyone removes pubic hair, and transmission remains possible through close body contact or shared items like towels or bedding.

In other words, crabs have not gone extinct. They may simply be less visible or less frequently reported. For this reason, it is still important to include pubic lice in broader discussions about sexual health and STD symptoms, especially for individuals who experience itching or other signs after sexual contact.

How to Avoid Crabs: Prevention Tips That Actually Work

Here are practical steps you can take to reduce your risk of getting pubic lice:

• Avoid direct skin-to-skin contact with anyone who may be infested, especially during sexual activity.
• Use condoms to reduce the risk of STDs, although they may not fully prevent the spread of lice since lice can live in areas not covered by a condom.
• Do not share personal items like towels, bedsheets, or clothing, especially in communal living environments.
• In shared spaces like hostels or dormitories, only use freshly laundered linens and avoid contact with unwashed items.
• Consider grooming practices such as trimming or removing pubic hair, which may make it harder for lice to attach, though this is not a guaranteed prevention method.
• Check for signs such as itching, red bumps, or visible nits after sexual contact, particularly with new or casual partners.
• Encourage sexual partners to do the same and communicate openly about any symptoms or past infestations.
• Schedule regular sexual health check-ups. Routine STD testing in Singapore can help detect infections early, even if no symptoms are present.

Taking these precautions can help protect you and your partners while promoting better overall sexual health.

Where to Get Help in Singapore: Clinics, Testing, and More

If you suspect you have pubic lice or may have been exposed to other STDs, here’s where and how to get help:

• Visit Shim Clinic, a STD clinic in Singapore offering private, walk-in consultations for sexual health concerns.
• Get checked for crabs and related infections through STD testing in Singapore. Many STDs present with minimal or no symptoms.
• If you’ve recently had unprotected sex, consider screening for chlamydia, gonorrhoea, syphilis, or herpes.
• Concerned about HIV? Access same-day HIV testing in Singapore or learn more about HIV PEP in Singapore and HIV PrEP in Singapore.
• For other less visible but common infections, consider testing for HPV, hepatitis B, trichomoniasis, or genital warts.
• Learn to recognise STD symptoms, especially if you experience itching, bumps, or unusual discharge after sexual contact.
• Shim Clinic provides confidential consultations and same-day testing with no appointment required.