Sexually Transmitted Infections: Molluscum Contagiosum

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Chapter 54 Sexually Transmitted Infections: Molluscum Contagiosum

INTRODUCTION

Description: Molluscum contagiosum is a papillary lesion caused by viral infection (pox virus) that is spread by skin to skin contact, first described in 1817.
Prevalence: Two of 100,000, 1 of 40 to 60 patients with gonorrhea, about 1% of all skin disorders in the United States.
Predominant Age: Early reproductive.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Molluscum contagiosum is caused by the largest member of the pox virus group. This mildly contagious DNA virus infects epithelial tissues, and autoinoculation to other sites is common. The appearance of lesions ranges from 1 week to 6 months, with an average incubation period of 6 weeks. (The virus can also infect other primates and kangaroos.)
Risk Factors: Sexual activity and direct exposure to the infective agent.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Asymptomatic
• After several weeks of incubation, a round, umbilicated papule, 1 to 5 mm in size, with a yellow, waxy core of cheesy material (these lesions may grow slowly for months; they may be solitary or occur in clusters) may occur
• Eczema (10%)

The lesions of molluscum are highly contagious, and appropriate precautions should be used when examining the lesions or material from the lesions to avoid infection or spread.

DIAGNOSTIC APPROACH

Differential Diagnosis

• Sebaceous cysts
• Folliculitis
• Herpes simplex
• Dermal papilloma
• Nevus

Associated Conditions: Other sexually transmitted infections.

Workup and Evaluation

Laboratory: No evaluation indicated. Because patients who are immunosuppressed are at higher risk for molluscum, testing for human immunodeficiency virus infection should be considered.
Imaging: No imaging indicated.
Special Tests: Material from the lesions is examined microscopically; inclusion bodies are seen in material from the core of the lesion.
Diagnostic Procedures: Clinical picture and examination of material from lesion.

Pathologic Findings

Eosinophilic inclusion bodies (intracytoplasmic) in material from the core of the lesion.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Local care.
Specific Measures: Molluscum lesions may go away on their own in 6 to 9 months but can persist, via autoinoculation, for up to 4 years. Treatment is based on obliterating the lesion. This is done by desiccation, cryotherapy, curettage, laser ablation, or chemical cautery (AgNO3; may cause hyperpigmentation and scarring). Curettage of the base of the lesion (with the tip of an 18-gauge needle or curette) is also curative. Bleeding may be controlled with Monsel’s solution (ferric subsulfate solution 20%).
Diet: No specific dietary changes indicated.
Activity: No restriction. (Sexual continence required until infection is resolved.)
Patient Education: American College of Obstetricians and Gynecologists Patient Education Pamphlet AP009 (How to Prevent Sexually Transmitted Diseases). Patients should be advised to have all sexual partners seen for diagnosis and treatment.

Drug(s) of Choice

None.

FOLLOW-UP

Patient Monitoring: Follow-up should occur in 1 month to look for new lesions.
Prevention/Avoidance: Limitation or elimination of risky behavior (sexual promiscuity).
Possible Complications: Local secondary infection.
Expected Outcome: Good response to lesion destruction—generally heals with little or no scarring.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy.
ICD-9-CM Codes: 078.0.

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REFERENCES

Level I

Hanna D, Hatami A, Powell J, et al. A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children. Pediatr Dermatol. 2006;23:574.

Level II

Hughes P. Treatment of molluscum contagiosum with the 585-nm pulsed dye laser. Dermatol Surg. 1998;24:229.

Papa C, Berger R. Venereal herpes-like molluscum contagiosum: treatment with tretinoin. Cutis. 1976;18:537.

Smith MA, Singer C. Sexually transmitted viruses other than HIV and papillomavirus. Urol Clin North Am. 1992;19:47.

Tyring SK. Molluscum contagiosum: the importance of early diagnosis and treatment. Am J Obstet Gynecol. 2003;189:S12.

Weller R, O’Callaghan CJ, MacSween RM, White MI. Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation. BMJ. 1999;319:1540.

Level III

Blattner RJ. Molluscum contagiosum: eruptive infection in atopic dermatitis. J Pediatr. 1967;70:997.

Brown ST, Nalley JF, Kraus SJ. Molluscum contagiosum. Sex Transm Dis. 1981;8:227.

de la Maza LM, Peterson EM. Genital infections. Med Clin North Am. 1983;67:1059.

Cohen J, Powderly WG. Infectious diseases, 2nd ed., New York: Elsevier; 2004:2053.

Eckert LO, Lentz GM. Infections of the lower genital tract. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:575.

Gottlieb SL, Myskowski PL. Molluscum contagiosum. Int J Dermatol. 1994;33:453.

Margolis S. Genital warts and molluscum contagiosum. Urol Clin North Am. 1984;11:163.

Reed RJ, Parkinson RP. The histogenesis of molluscum contagiosum. Am J Surg Pathol. 1977;1:161.

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