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“I've got the sidies doc!” I look blankly at the young Scouser1 in front of me. Neither membership nor the diploma in venereology seemed to be helping me with this one. With an air of resigned patience, he kindly explained to me that “sidies” were “crabs.” “Have you never seen one doc? They go sideways, hence sidies.” Now, why hadn't I thought of that! I was learning a lot in Liverpool.
It is always a difficult one. “Why did I get these doc? Is it a sexually transmitted disease?” In the explanation, I often use the phrase that crabs are sexually transmissible, but not necessarily always sexually transmitted.
It is indeed very satisfying though to be able to make a clinical diagnosis with 100% accuracy, and there is always a great sense of satisfaction in telling a patient who has attended with a problem of itching that “yes, it is definitely crabs.” It's even better if there happens to be a young impressionable medical student present, and one can entice one of the crabs on to a glass slide, and then look at it thrashing about under the microscope. Funny how medical students often remember a case of crabs, and we need to use every gimmick possible these days to try and entice medical students to consider the specialty of genitourinary medicine in their future plans. With the new problem based learning2 modules—that is, the FOFO method (“F….. Off and Find Out”), as they fondly refer to it, most medical students get little contact with our specialty. Our only other hope is that they might be lucky enough to contract an STD and thus have to use the service and be impressed by it. This scenario has proved valuable for past recruitment but current medical students are so serious, studious, and abstemious that this is unlikely to match the recruitment levels of old!
It is extraordinary the lengths to which some patients go to try and get rid of the crabs before attending. For example, I have seen some nasty burns from neat Dettol, and the dexterity and skill required to do a complete genital shave is well beyond the normal male competence. It is quite an alarming sight to see shaved male genitalia with nicks and cuts all over, with bits of tissue paper stuck on in an attempt to stem the flow of blood. As for post-scrotal shaving trauma …Enough said!
Luckily, crabs are usually very sensitive to the treatments we prescribe and a single course of Derbac often does the trick. (I still marvel at the sense of humour of the company in coming up with the name Derbac, which is really a reworking of the letters decrab!) It is also supposed to work for head lice, but recent experience with my kids has been disappointing and clearance was only achieved in the end by buying the “nit busters pack” (tee tree oil, shampoo, conditioner, and a nit comb) in Body Shop. Mind you, it is a bit embarrassing to be in a packed local Body Shop store and have the teenage assistant shout out “Hey, Tracy, how much are these nit buster packs?”
Finally, I learnt a good lesson once in the Seamen's Dispensary in Liverpool, in the days when I was young and enthusiastic and keen to explain everything to everybody. I remember pointing out to a patient that he had crabs, and when he said “where,” I pointed to one in the pubic hair and saying “there, look, see—right there, there's one,” at which point the patient picked it off, scrutinised it, and flicked it somewhere. I couldn't believe it, I was absolutely seething. There I was frantically brushing down my clothes and stamping on the urine encrusted floor of the Seamen's Dispensary in the hope of killing the little mite. “How could you have done that? What am I going to say to my wife in two weeks' time, if I develop crabs? Do you think she would believe this story?” “Well, Doc, you can tell her, that although it's sexually transmissible, it is not always sexually transmitted!”
1Scouser: Liverpudlian, derived from the word Labskaus—a northern European sailor's dish. Scouse (a form of cheap pale grey Irish stew) became a common Liverpool delicacy.
2Problem based learning: The new medical student curriculum where an eternity of lectures has been replaced with the aspiration of self directed education.
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