Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• STD Treatment Guidelines   at http://www.cdc.gov/STD/treatment

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV Prevention

ECTOPARASITIC INFECTIONS

Pediculosis Pubis
     
     Patients with pediculosis pubis (pubic lice) usually seek
medical attention because of pruritus. Commonly, they also notice
lice on pubic hair.

Recommended Regimens -
     Lindane 1% shampoo applied for 4 minutes and then thoroughly
     washed off (not recommended for pregnant or lactating women or for
     children less than 2 years of age)
                              or
     Permethrin 1% creme rinse applied to affected areas and washed
     off after 10 minutes
                              or
     Pyrethrins with piperonyl butoxide applied to the affected
     area and washed off after 10 minutes.

     The lindane regimen remains the least expensive therapy;
toxicity (as indicated by seizure and aplastic anemia) has not been
reported when treatment is limited to the recommended 4-minute
period. Permethrin has less potential for toxicity in the event of
inappropriate use.

Other Management Considerations
     The recommended regimens should not be applied to the eyes.
Pediculosis of the eyelashes should be treated by applying
occlusive ophthalmic ointment to the eyelid margins two times a day
for 10 days.

     Bedding and clothing should be decontaminated (machine washed
or machine dried using heat cycle or dry-cleaned) or removed from
body contact for at least 72 hours. Fumigation of living areas is
not necessary.

Follow-Up
     Patients should be evaluated after 1 week if symptoms persist.
Re-treatment may be necessary if lice are found or if eggs are
observed at the hair-skin junction. Patients who are not responding
to one of the recommended regimens should be retreated with an
alternative regimen.

Management of Sex Partners
     Sex partners within the last month should be treated.

Special Considerations

Pregnancy -
     Pregnant and lactating women should be treated with permethrin
or pyrethrins with piperonyl butoxide.

HIV Infection -
     Persons with HIV infection and pediculosis pubis should
receive the same treatment as those without HIV infection.

Scabies
     
     The predominant symptom of scabies is pruritus. For pruritus
to occur, sensitization to Sarcoptes scabiei must occur. Among
persons with their first infection, sensitization takes several
weeks to develop, while pruritus may occur within 24 hours after
reinfestation. Scabies among adults may be sexually transmitted,
although scabies among children is usually not sexually
transmitted.

Recommended Regimen -
     Permethrin cream (5%) applied to all areas of the body from
     the neck down and washed off after 8-14 hours,
                         or
     Lindane (1%) 1 oz. of lotion or 30 g of cream applied thinly
     to all areas of the body from the neck down and washed off
     thoroughly after 8 hours.

NOTE: Lindane should not be used following a bath, and it
should not be used by persons with extensive dermatitis, pregnant
or lactating women, and children less than 2 years of age.

Alternative Regimen -
     Crotamiton (10%) applied to the entire body from the neck
     down, nightly for 2 consecutive nights, and washed off 24 hours
     after the second application.

     Permethrin is effective and safe but costs more than lindane.
Lindane is effective in most areas of the country, but lindane
resistance has been reported in some areas of the world, including
parts of the United States. Seizures have occurred when lindane was
applied after a bath or used by patients with extensive dermatitis.
Aplastic anemia following lindane use also has been reported.

Other Management Considerations
     Bedding and clothing should be decontaminated (machine washed
or machine dried using hot cycle or dry-cleaned) or removed from
body contact for at least 72 hours. Fumigation of living areas is
not necessary.

Follow-Up
     Pruritus may persist for several weeks. Some experts recommend
re-treatment after 1 week for patients who are still symptomatic;
other experts recommend re-treatment only if live mites can be
observed. Patients who are not responding to the recommended
treatment should be retreated with an alternative regimen.

Management of Sex Partners
     Both sexual and close personal or household contacts within
the last month should be examined and treated.

Special Considerations

Pregnant Women, Infants, and Young Children -
     Infants, young children, and pregnant and lactating women
should not be treated with lindane. They may be treated with
permethrin or crotamiton regimens.

HIV Infection -
     Persons with HIV infection and uncomplicated scabies should
receive the same treatment as persons without HIV infection.
Persons with HIV infection and others who are immunosuppressed are
at increased risk for Norwegian scabies, a disseminated
dermatologic infection. Such patients should be managed in
consultation with an expert.

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