Coming to terms with Sexually Transmitted Disease: Scabies

Scabies has been around for a long time and is probably responsible for the term, “Seven Year Itch.” These bugs have three pairs of strong, stubby legs, which the female uses to burrow under the skin.

This extremely common skin infestation has been on the rise in the United States since 1973. Actual prevalence rates are unknown, but epidemics appear to be associated with wars. Unlike other parasitic infestations such as pubic lice, scabies is hard to contract. It requires prolonged contact with an infected person or infected belongings such as bedding.

MICROSCOPIC SOURCE OF “THE SEVEN YEAR ITCH”

You'll never see the tiny bugs called scabies. Instead, their presence is announced by the severe itching they cause as they burrow under the skin. Unlike crabs, they are picked up only through prolonged contact with an infected person. Though they do not pose a serious threat to your health, you'll want to get rid of them as quickly possible, using a preparation such as Elimite, Eurax, or Kwell.

• Risk factors: You are more likely to get scabies if you or your partner have multiple or casual sexual partners. Overcrowded living conditions, poor hygiene, and malnutrition probably contribute to the problem.

• Signs and symptoms: Itching, which gets worse at night, after exercise, or after hot baths or showers, is the main complaint with scabies. Hands, arms, feet, ankles, armpits and buttocks, as well as the genitals, can all be affected.

Scabies are so tiny, they can not be seen with the naked eye. However, you can often see the burrows under the skin made by the female when she lays her eggs, particularly in the spaces between your fingers.

• Cause: Scabies is caused by the mites Sarcoptes scabiei var hominis. It is passed from person to person through close contact, including sexual activity. It can also spread through sheets, clothes and furniture.

• Incubation period: The typical incubation time is five weeks, but since symptoms are due to an allergic reaction, if you've had scabies before, you'll notice symptoms sooner.

• Possible health affects: Approximately 7 percent of all people infected with scabies get a rash of itchy, reddish-brown bumps, especially on the genitals. This is just a more severe allergic reaction than normal but it may take weeks or months to disappear. People whose immune systems are working overtime—for example, those who've had another illness for a long time—may notice thick, flaky lesions on their skin. This is called Norwegian scabies, and it is extremely contagious.

• Diagnosis: You will probably be able to see the burrows made by the female under your skin. If you're not sure it's a scabies burrow, you can apply some blue or black ink from a pen or marker to the suspect area. Soak a cotton swab with alcohol and rub off the excess ink. If you're dealing with a burrow, the ink will be sucked into it and you will be able to see a thin line of ink under your skin. For an exact diagnosis, your doctor can scrape off some affected skin and examine it under a microscope.

• Treatments: There are several recommended treatment regimens. One is 5 percent permethrin cream (Elimite) applied all over the body, and washed off eight to 14 hours later. Another treatment is a one ounce application of 1 percent lindane lotion or 30 grams of lindane cream (Kwell) applied thinly all over the body and washed off eight hours later. Both of these treatment are effective, but lindane is less expensive. Lindane should not be used by people with extreme dermatitis because this could cause seizures.

Crotamiton 10% (Eurax) can also be used. It is applied after a bath or shower, with a second application 24 hours later. A cleansing bath should be taken 48 hours after the last application.

• Follow-up: You might be asked to come in for a follow-up after a week if the symptoms do not disappear. It is normal to feel itchy several weeks after treatment. All sex partners from the last month should be notified and treated, and family members should be checked too. Clothing and bed linen used in the two days prior to treatment should be washed and dried, or dry cleaned.

• Prevention: There is no certain prevention, but since scabies are mostly spread in environments where there is a lack of good hygiene, avoid using unclean towels, bedding, and clothing.

• Pregnancy: Pregnant or breastfeeding women should not use treatments containing lindane.

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