The ectoparasite, Pthirus pubis (PtP), (crab or pubic louse) has plagued primates from pre-historic apes to Homo sapiens. We combed the literature from antiquity to present day using Medline and EMBASE, reviewing the pubic louse's origins, its evolution with mankind, presentation and management. Medline and EMBASE provided the greatest yield of literature compared to other databases. PtP incidence estimates range from 0.3-4.6% and prevalence around 2% in adults. War, disasters and overcrowding support lice transmission, but modern pubic hair grooming has reduced PtP in recent years. PtP, is usually found on pubic hair, but may infest scalp, eyebrows, eyelashes and body hair. Reports suggest the possibility of PtP as a vector for Bartonella spp. and Acinetobacter spp., requiring further studies. Transmission is via close contact, so sexual abuse and concomitant STIs should be considered. Symptoms and signs include: pruritus, red papules and rust/brown deposits from feeding or faecal matter. Visualisation of live lice confirms diagnosis. Long-standing treatments include hand-picking and combing, but in modern times pediculicidal products may generate faster resolution. Permethrin or pyrethrins are first-line recommendations. Resistance to pediculicides is common with head lice and is presumed likely in PtP although data are lacking. Pseudo-resistance occurs due to poor compliance, incorrect or ineffective dosing and reinfestation. In true resistance, a different pediculicide class should be used e.g., second-line agents: phenothrin, malathion or ivermectin. Lice have existed long before humans and given their adaptability, despite habitat challenges from fashion trends in body hair-removal, are likely to continue to survive.