Dear Dr. G,

I am desperate and would like your help at your soonest convenience.

I have a confession to make, as I have been shamefully naughty lately.

I am a 49-year-old man and have been married for many years. As my wife is also of similar age, she is experiencing menopause and declining sex drive.

We have not been that sexually active lately, causing tremendous amount of sexual frustration.

I really didn’t know what I was thinking, but the “itch” had led me to visit a massage parlour and I had sexual encounter with a sex worker.

Despite using protection during the intercourse, I began to experience itchiness and rash around my pubic area a few days following the encounter.

Apart from the itchiness, I did not experience any discharge or urinary symptoms.

As the itch became intensified and overpoweringly irritating, I was scratching the pubes so much that it bleeds.

I went to the doctors and who told me I have contracted scabies.

Naturally, I was shocked and would like to put Dr. G on the spot to help me.

What exactly is scabies and how can the disease be transmitted despite using condoms?

How can the scabies be treated, as my itch in the pubes is driving me up the wall?

Most importantly, I must also confess my wife also complained of the itch in the pubes in recent days. Do you think she has also contracted scabies through me, as we also had sex lately?

I really hope Dr. G can help me to get rid of this itch in the pubes and most importantly the disastrous consequence of my seven-year itch.

Itchy man

Scabies is a contagious skin infection caused by the mite Sarcoptes Scabiei. Ironically, this is also referred as “the seven-year itch”, as the name implies irritating and contagious complaint of a long duration. In a psychological term, the seven-year itch suggests the intensity of happiness in a relationship declines after around year seven of a marriage. The phrase was first used to describe an inclination to become unfaithful after seven years of marriage in the play by George Axelrod, which gained popularity following the film adaptation by Marilyn Monroe and Tom Ewell.

In fact, scabies has been observed in humans since ancient times. Archaeological evidence from Egypt suggests scabies was present as early as 494 BC. Aristotle reported in the fourth century on “lice” that “escape from pimples if they are pricked” (I assumed the prick was referring to puncturing of skin, and not otherwise) and the description was consistent with the contagious scabies.

Scabies is contracted through relative long period of physical contact (around 10 minutes) with an infested individual, which includes sexual intercourse. Less commonly, scabies is transmissible through the sharing of clothes and bedding, as the mites can only survive two to three days away from the warmth of the human skin. As with lice, a latex condom is ineffective against scabies transmission during protected intercourse, as the mites typically migrate from one individual to the next at pubic areas not covered by the rubbers.

Scabies is caused by the female mites burrowing into the skin to live and deposit eggs. In fact the symptoms of scabies are due to the allergic reactions to the mites. Tiny burrows are usually seen in the skin and these induce pimple-like rash and severe itch. The itch is often worse at night, and the scratching may even cause skin breakdown and secondary bacterial infection.

Insecticides such as Permethrin is applied from neck down before bedtime for about eight hours, and washed in the morning. Moreover, the treatment should involve the entire household and any other with prolonged contact with the infested individuals. Beddings, clothing and towels used during the previous three days should also be washed in hot water and dried in a hot dryer. Finally, the control of itchiness including antihistamine and anti-inflammatory agents are often a temporary relief until the eradications of the mites.

John Lennon’s widow, Yoko Ono once said: “Marriage is a difficult project. When the seven years have passed and your body’s cells have been replaced. You are meant to experience that seven-year itch”. Although it is natural for couples to face the challenges of declining sexual libido in a relationship, the “itch” being a reason for infidelity is often an excuse. When Dr. G is put on the spot by men facing the consequences of the intense itch of scabies due to excuses of “seven-year itch”, the only advice he can give is to eat the humble pie and come clean, because “when the seven days of scratching have passed and your cells have changed, the itchy pubes will definitely drive you up the wall!”

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