Molluscum contagiosum diagnosis and management

Last updated: June 2013

Diagnosis

Clinical presentation

  • Appearance of typical hemispherical, smooth, umbilicated, pearly lesions
  • cryotherapy demonstrates umbilication of the lesion
  • lesions are frequently present on the pubis, inner thighs or genitals. They may also occur at other sites from non-sexual exposure
  • lesions exhibit the Koebner phenomenon
  • lesions may be extensive, larger and atypical in appearance in immunocompromised patients.

Treatment

Cryotherapy

  • Freeze for 10 to 30 seconds
  • individual lesions should resolve after a single treatment but it is not unusual for new lesions to appear in the following days or weeks
  • treatment can be repeated at weekly intervals until resolution.

Currettage

  • The core of medium or large lesions is removed by slitting the capsule with the edge of a 19 gauge needle.
  • To prevent spread and secondary infection, povidone-iodine (Betadine) should be applied following treatment.

Patient education

The following points should be covered:

  • the nature of the infection as a benign self-limiting viral skin infection
  • the infection is spread by close physical contact. In adults with lesions on or near the genitals it is usually sexually transmitted
  • the natural history is of spontaneous regression of lesions within twelve months.
  • the aim of treatment is to decrease the duration of clinical lesions, but may also reduce infectivity.
  • the use of condoms may reduce but not fully prevent onward transmission
  • advise the patient against scratching, shaving or waxing in affected areas, which may spread the lesions
  • cryotherapy may cause scarring and pigment changes
  • the presence of molluscum indicates the need for a complete sexually transmitted infections (STI)/human immunodeficiency virus (HIV) screen.

Follow up

Clinical review 5 to 10 days after completion of treatment.

Further information

For further information on the diagnosis and management of molluscum contagiosum contact Adelaide Sexual Health Centre.

Disclaimer

These guidelines are based on review of current literature, current recommendations of the United States Centers for Disease Control and Prevention, World Health Organization, the British Association for Sexual Health and HIV and local expert opinion.

They are written primarily for use by Adelaide Sexual Health Centre staff and some flexibility is required in applying them to certain private practice situations.