Sexual Health Advice - Patient Information Leaflets

Scabies

What causes scabies?

Scabies is caused by a mite (a tiny insect). They are about 0.4 mm long i.e. smaller than a pinhead. The eggs hatch into mites after a few days.

How do you get scabies?

Scabies is usually transmitted by direct body contact or simply by close physical contact with someone who has scabies. It can also be passed from one person to another during sex. The mites can be found in the genital area, on the hands between the fingers, on the wrists and elbows, underneath the arms, on the breasts, on the feet and ankles and around the buttocks. They can live for up to 72 hours off the body, so occasionally scabies can be spread by clothing, bedding and towels.

Both men and women can get scabies and pass it on.

What are the symptoms of scabies?

Some people will not have any visible signs or symptoms at all, or not be aware of them.

The itch and rash of scabies are due to an allergy to the mites. These symptoms usually take 2 – 6 weeks to occur after you are infected. You may not know that you are infected and you may pass on the mites to others before you have any symptoms.

If you do get symptoms they may include:

Itch which can often be severe. Itchy skin tends to be in one area at first (often the hands) and then spreads to other parts of the body. The itch tends to be worse at night and after a hot bath.

A rash usually appears soon after the itch starts. It is typically a blotchy red rash that can appear anywhere on the body. It is often most obvious on the inside of the thighs, parts of the abdomen, and the ankles.

Mite tunnels (burrows) may be seen on the skin as fine, dark or silvery lines about 2 - 10 mm long. The most common areas where they occur are the loose skin between the fingers, the front of wrists and elbows, the groin, armpits, under breasts, scrotum, and penis.

Scratching sometimes causes slight skin damage. In some cases the damaged skin becomes infected by bacteria – a ‘secondary' skin infection. Skin infected with bacteria becomes red, inflamed, hot and tender.

Some people believe that they are ‘covered in mites'. This is usually not so. Commonly there are just a few mites on the skin. But, the allergy to mites can cause you to itch all over, and for a rash to appear in many parts of the body.

Who should be treated for scabies?

The affected person and all household members and sleeping / sexual partners of the affected person – even if they have no symptoms. This is because it can take up to 6 weeks to develop symptoms after you become infected. Close contacts may be infected, but have no symptoms, and may pass on the mites.

How is scabies diagnosed?

A doctor or nurse can often tell you have scabies just by looking at the affected areas.

They may gently take a skin flake from one of the spots and look at it under the microscope to see if a mite is present.

Your doctor/nurse may advise you are tested for other sexually transmitted diseases if sexual contact is the likely cause of scabies.

What is the treatment for scabies?

The usual treatment is either a cream containing permethrin or a lotion containing malathion. These kill the mite. You can buy them over the counter. You can also get them on prescription. They are easy to apply and normally work well if used properly. Re-apply the same treatment seven days after the first application. This helps to make sure that all the mites are killed. Avoid sex or close body contact with your partner until you have both finished the second treatment application, otherwise you could be re-infected.

Follow the instructions on the packet. The following is a general guide giving tips for success.

You need to treat all the skin of your body (including the back, soles of the feet, between fingers and toes, under fingernails, scalp, neck, face, ears and genitals).

An adult needs at least 30g of cream or 100 ml lotion to cover the whole body. So, for two applications you will need at least 60 g of cream or 200 ml lotion per adult.

A small paintbrush is a good way of applying a lotion, but use cotton wool for sensitive areas such as the penis. A water based lotion is preferable as alcohol based lotions may sting.

Apply cream or lotion to cool dry skin (not after a hot bath).

The cream or lotion should be left on for the full recommended time. Depending on which one you use, this may be between 8 and 24 hours.

Children should stay off school until the first application of treatment has been completed.

If you wash your hands or any other part of your body during the treatment period, you should re-apply the cream or lotion to the washed areas.

Clothes, towels, and bed linen should be machine washed (at 50ºC or above) after the first application of treatment. This is to prevent re-infestation and transmission to others. Items that cannot be washed can be kept in plastic bags for at least 72 hours to contain the mites until they die.

Tell the pharmacist or doctor if treatment is for pregnant or breast feeding women, or babies under 6 months.

Put mittens on babies to stop them licking the cream or lotion off their hands.

Some people who develop a secondary skin infection may also need antibiotics.

Note: you will still be itchy for a while after successful treatment

It is normal to take up to 2 – 3 weeks for the itch to go completely after the mites have been killed by treatment. A soothing cream such as crotamiton may help until the itch eases. An antihistamine medicine such as chlorpheniramine may also be useful to help you sleep if itching is a problem at night (particularly for children). A pharmacist can advise about these.

See a doctor if the itch persists longer than 2 – 3 weeks after treatment. Sometimes the first treatment does not work, and a different one is then needed. However, the common reasons why treatment fails, or for scabies to recur are:

The cream or lotion is not put on correctly for the full time, or

A close contact is not treated at the same time, and the infection is passed back and forth.

Currently, there is no evidence that complementary therapies can treat scabies.

How will I know how long I have had scabies?

It can be impossible to know. It is possible that your partner may have scabies and not know. You might never know whether you got it from your current or a previous sexual partner. This can often be difficult to handle. Do not be afraid to talk to clinic staff about how you feel.

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