What disease should the physician consider if the patient volunteers that his spouse also suffers from itching?

This history suggests an arthropod reaction, such as scabies or pediculosis pubis. Scabies commonly infects the entire family, especially if young children are present. The characteristic primary lesion is a burrow. Burrows may be difficult to visualize but are most commonly located on the flexor wrists, fingerwebs, and glans penis. Vesicles, papules, pustules, and excoriations are other skin lesions that may be present. Women often complain of pruritus about the nipples. Nocturnal itching is also characteristic of scabies.

If both members of the family have genital itching, the patient should be examined for pubic lice (Phthirus pubis) and nits attached to pubic hairs. Pediculosis pubis is one of the most infectious sexually transmitted diseases. Individuals have a 95% chance of becoming infected after a single exposure to an infected partner.