First-line treatment for pubic lice (pediculosis pubis) is

• A. Oral metronidazole
• B. Topical steroids
• C. Topical permethrin or pyrethrin
• D. Oral antifungals

Answer: (C)

Pubic lice are treated with a topical pediculicide because you need to kill the lice directly on the hair in the groin area. The first-line options are permethrin 1% cream or pyrethrin-based preparations. These are effective at killing both live lice and, with proper use, their eggs, and they have a favorable safety profile for topical use. Typically, you apply the product to the affected area and wash it off after the recommended time; a second treatment is often given 7–10 days later if nits or live lice persist.

Other options listed don’t address the infestation: metronidazole targets protozoa like Trichomonas or anaerobes, not lice; topical steroids reduce itching but don’t eradicate the lice; antifungals treat fungi, not lice. If initial treatment fails, alternatives such as oral agents may be considered, but topical permethrin or pyrethrins remain the first choice.