Written on August 22, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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An estimated 300 million people get infected with scabies globally each year. In 2009, the World Health Organization determined that scabies was a neglected skin disease that had a significant health impact in developing countries. Scabies has high prevalence rates in regions of Africa, South America, Australia, and Southeast Asia. The prevalence rate was associated with increased poverty, poor nutritional status, homelessness, and inadequate hygiene.
Scabies is usually described as a skin infection. But sometimes the question arises if scabies is also a sexually transmitted disease (STD). Knowing what causes scabies and how the disease process occurs can help you better protect yourself.
Scabies is a skin disease caused by infection with a parasite, or mite, called Sarcoptes scabiei var. hominis.[1,2]Scabies can rapidly spread to others in crowded conditions. The scabies mite is typically transmitted from one infected person to another by direct, prolonged, skin-to-skin contact. The mite is microscopic — meaning it is so tiny that it cannot be seen with the naked eye — only visible with a microscope. Once transmitted, the scabies mite burrows into the upper layer of the skin, where it can survive and lay up to 2 to 3 eggs a day.[1,2]
The most common scabies symptom is intense itching and pimple-like skin rashes.[1,2] For a first scabies infection, it may take several weeks before the itching occurs.[2,3] Subsequent reinfection with the scabies mite can lead to itching within 24 hours. The itching can also be more severe at night with scabies.[2,4] The rashes can occur with tiny blisters or vesicles, which may present about two to five weeks after infection.[1,2] Crusted scabies, a more severe form of scabies in people with weak immune systems, may not always display the typical symptoms of itching and rash.
Scabies is mainly found in the folds of the skin but can be found anywhere on the body. The intense itching and rash with scabies may be similar to STD symptoms, especially if occurring around the genital areas. Various parts of the body where scabies can occur in adults include:[1-4]
Scabies is essentially a skin infection. Scabies is also considered an STD because it can be transmitted during sexual activity with skin-to-skin contact.[2,3] Scabies is frequently acquired through sexual contact in adults. The genitals can become infected with the mite, and scabies symptoms can present in this area.[1-4]
Scabies can be diagnosed by identifying burrows, mites, eggs, or mite feces from the affected areas of the body. Microscopic identification of the mite from skin scrapings is an option, but this method takes a long time and does not reliably detect the presence of the infection. Other reliable noninvasive examination tools of the affected skin areas exist to help diagnose scabies, such as video microscopy or dermoscopy. The Burrows Ink Test and the adhesive tape tests are low-technology strategies that can also diagnose scabies.
According to the Centers for Disease Control and Prevention treatment guidelines, the recommended treatment regimen for scabies is permethrin 5% cream or ivermectin. Permethrin 5% cream is applied all over the body from the neck down and washed off after eight to 14 hours. Ivermectin is weight-based and is taken orally, with a second dose taken 14 days later. Ivermectin has limited activity on the mite eggs; therefore, the second dose should be taken 14 days after the first dose. The alternate regimen for scabies is lindane 1% applied all over the body from the neck down and washed off after eight hours. Do not use lindane in children less than 10 years old.
As part of treatment, there are other considerations to help prevent reinfection with scabies. Disinfect bedding and clothing by machine washing and drying using the heat cycle, dry cleaning, or removing from body contact for more than 72 hours. Closely trim fingernails to decrease injury from excessive scratching during scabies infection. Following up with your healthcare provider after the initial treatment regimen is essential to ensure an appropriate response.
If you have signs and symptoms that you think might be scabies-related, or you may have been exposed to a sexually transmitted disease, you can schedule a virtual consult with a healthcare provider. Everlywell has a telehealth option where you can make an on-demand STD telehealth appointment and connect with a clinician in less than two hours. If applicable, you can get treatment and have your prescription sent directly to your pharmacy.