Anecdotal experience in our clinic suggests a recent reduction in cases of pubic lice despite increased patient numbers and increasing prevalence rates of other sexually transmitted infections (STIs). Also, in recent years we have seen an increasing number of patients who have undergone extensive pubic hair removal procedures, such as the “Brazilian.” Could there be an association between the rates of pubic lice and the introduction of pubic hair removal practices? We have looked at the prevalence rates of pubic lice in relation to hair removal practices and, for comparison, also looked at the rates of gonorrhoea and chlamydia over the same period.
Annual cases of pubic lice, chlamydia, and gonorrhoea diagnosed at the Department of Genitourinary Medicine, Leeds, were obtained for 1997–2003. Prevalence rates were calculated by dividing these figures by new patient numbers. Changes in percentages were analysed using the χ2 test and odds ratios.
The rates for gonorrhoea, chlamydia, and pubic lice between 1997 and 2003 are shown in figure 1.
Figure 1 Prevalence of chlamydia, gonorrhoea, and pubic lice in all patients, Department of Genitouriary Medicine, LGI, 1997–2003.
Comparing 2003 with 1997 there was a significant drop in the rate of pubic lice (OR 0.41; 95% CI 0.23 to 0.70 p = 0.0004), whereas there was a significant increase in gonorrhoea (OR 2.18; 95% CI 1.86 to 3.48 p = <0.0001) and chlamydia (OR 1.31; 95% CI 1.21 to 1.43 p = <0.0001).
In female patients the significant fall occurred in 2000 (2000 compared with 1997: OR 0.28; 95% CI 0.08 to 0.92 p = 0.02), whereas in men the significant drop was later in 2003 (2003 compared with 1997: OR 0.40; 95% CI 0.22 to 0.75 p = 0.02).
Despite rises in the prevalence of chlamydia and gonorrhoea, there has been a significant drop in pubic lice over recent years. Sexual behaviour changes cannot account for this discordance in trends of STIs so there must be another explanation. The drop in pubic lice in women appears to be most dramatic around 2000 and coincided with the introduction of extensive waxing techniques, such as the “Brazilian,” in women in the United Kingdom.
The “Brazilian” is essentially a normal bikini wax leaving a little “landing strip” of hair or nothing at all. Its origins lie in Brazil where waxing has long been part of the culture. Initially the “Brazilian” was only available at selected London salons but by 2000–1 it had become a widely available and increasingly popular waxing technique across the United Kingdom.
Although initially predominantly seen in females, extensive hair depilation, including pubic hair, has become popular in males in the past few years. This, along with reduced transmission rates from female partners, may account for the recent similar reduction in male patients.
Our findings confirm a recent fall in prevalence of pubic lice, and show that in women this coincided with the emergence of the “Brazilian.” There are obviously many important methodological flaws in this study such as not having the rates of pubic hair removal in the patients. Also, there are other possible explanations for the findings, such as patients with pubic lice having difficulty gaining clinic appointments because of the current access problems. However, we think that this is an interesting observation and that hair removal practices may have contributed to the reduction in pubic lice.
Contributors
JDW conceived the idea; NRA collected the data, both authors wrote the paper and act as guarantors.
Footnotes
Funding: none
Competing interests: none.
Ethical approval for this study was not needed as departmental figures were used for the analysis. No information about individual patients was needed.