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[STDs] Molluscum Contagiosum

These are the images, diagnosis and treatment of the disease caused by Molluscum Contagiosum. This is a Viral Sexually Transmitted Diseases.


Molluscum contagiosum is a common cutaneous viral eruption that on cursory inspection may resemble warts. The molluscum contagiosum virus (MCV) is a pox virus; two types (MCV-1, MCV-2) have been described. The virus has not been cultivated, because only mature keratinocytes are susceptible and such cells have not been successfully propagated. The infection most commonly involves the face and upper extremities in young children, who are infected by contact with saliva of other children, typically in nursery or school settings. Genital area infection usually is sexually acquired and is common in sexually active teens and young adults, and probably occurs primarily in those who escaped childhood infection and lack protective immunity. In sexually active adults, molluscum usually involves the pubic area, lower abdomen, upper thighs, or buttocks, as well as external genitals. Facial lesions can occur in imunodeficient adults, such as persons with AIDS, probably the result of reactivation of latent infection when immune surveillance wanes. With few exceptions, molluscum contagiosum is a benign condition with few complications except for cosmetic effects and the psychological impact of a sexually transmitted disease (STD). Treatment is effective with any of several destructive methods, and most cases resolve within a few months without therapy.

EPIDEMIOLOGY

Incidence and Prevalence
• No reliable statistics available
• Rising frequency has been reported in some STD clinics in recent years

Transmission
• Sexual or salivary transmission
• Autoinoculation probably accounts for some cases of regional spread of lesions, e.g. by pubic shaving

Age
• Most cases occur in young children
• In sexually active adults, most common age is 15–30 years

Sex
• No known predisposition

Sexual Orientation
• No known predisposition

Other Risk Factors
• Cellular immunodeficiency risks late recrudescence; facial lesions can be a difficult management problem in patients with AIDS

HISTORY

Incubation Period
• Usually 2–3 months, range 1 week to 6 months

Symptoms
• Painless papules or wart-like bumps, often with a shiny pink appearance and central depression
• Sexually acquired lesions are located primarily in genital and perigenital areas, e.g., lower abdomen,
pubic area, upper thighs
• May be asymptomatic or unrecognized

Epidemiologic History
• Behavioral risks for STD
• Sometimes sexual contact with known case

PHYSICAL EXAMINATION
• In immunocompetent persons, usually several smooth, waxy, erythematous papules, often with central umbilication
• Most common on penis or labia, and perigenital locations (pubic area, upper thighs, scrotum, etc.)
• Facial, scalp, and other sites are common in children and persons with AIDS

DIAGNOSIS
• Usually diagnosed by clinical appearance
• May be confused with genital warts
• Examine small lesions under magnification
• Expression of hard, white core, followed by brisk bleeding confirms diagnosis
• Characteristic histopathology if lesions are biopsied
• Screen for other STDs

TREATMENT
• Few controlled trials reported, only in young children; recommendations in adults are based on uncontrolled observational reports
• Freezing by liquid nitrogen or cryoprobe
• Curettage
• Imiquimod 5% cream 3–5 times per week for up to 16 weeks
• If few in number, lesions may be unroofed with needle and core manually expressed, although this
may carry risk of local autoinoculation
• Podofilox, cantharadin, and other chemical irritants have been reported to be effective

SEX PARTNER MANAGEMENT
• Counsel patients to advise partners to seek treatment if lesions noted 

Multiple lesions of molluscum contagiosum on lower abdomen
10–1. Multiple lesions of molluscum contagiosum on lower abdomen. Individual 
lesions do not have emanating hairs or surrounding erythema, excluding 
folliculitis. Central umbilication, pink color, shiny appearance, 
and multiple lesions with little variation in size and morphology
distinguish molluscum from genital warts.  

CASE 1

Patient Profile Age 19, male college sophomore

History Painless pink growths on lower abdomen and pubic area, first noted 2 weeks earlier; sexually
active with new girlfriend for 2 months
Examination Numerous 1- to 3-mm smooth, erythematous, waxy papules, most with central umbilication; individual lesions not associated with hairs

Differential Diagnosis Molluscum contagiosum, genital warts, syphilis (condylomata lata), other papular eruptions; one lesion was unroofed with a needle and white core expressed, followed by brisk
bleeding

Laboratory Screening tests for chlamydial infection, gonorrhea, syphilis, and HIV

Diagnosis Molluscum contagiosum

Treatment Cryotherapy with liquid nitrogen, repeated in 1 week

Partner Management Advised to refer girlfriend if she notes lesions

Comment The lesions largely resolved following cryotherapy, but 2 weeks later several new lesions had appeared, a typical clinical course. The patient was prescribed imiquimod for self-treatment for subsequent lesions and advised that he should expect new lesions to stop appearing within 1–2 months.
Atypical molluscum contagiosum, with loss of superficial epithelium and presenting as a nodular vulvar ulcer.
10–2. Atypical molluscum contagiosum,
with loss of superficial epithelium and
presenting as a nodular vulvar ulcer.
Patient also has discharge due to bacterial vaginosis  


CASE 2

Patient Profile Age 20, single, enlisted woman in U.S. Army

History Painless vulvar “bump” for 1 week; malodorous vaginal discharge intermittently for an undetermined period; monogamous for past year, but boyfriend suspected to have other partners

Examination Nontender, nodular, ulcerated lesion of vulva with firm, white base; homogeneous, white vaginal discharge

Differential Diagnosis Syphilis, genital wart, herpes, chancroid, molluscum contagiosum, granuloma
inguinale, cancer

Laboratory Darkfield examination, VDRL, culture for HSV, and screening tests for N. gonorrhoeae and C. trachomatis (all negative); referred to dermatologist for biopsy; on attempt at punch biopsy, a hard white core was expressed; molluscum contagiosum was confirmed histologically; pH 5.0, amine odor test positive, clue cells seen microscopically

Diagnosis Molluscum contagiosum; bacterial vaginosis

Treatment Cryotherapy with liquid nitrogen; metronidazole 500 mg PO bid for 7 days

Partner Management Advised to refer partner for STD screening

Comment In this atypical case, the patient presented with ulcerated molluscum contagiosum, a rarely
recognized clinical entity. Partner evaluation for molluscum is recommended only when lesions are noted by partners, but the patient’s bacterial vaginosis and sexual history suggested value in STD screening of the partner. However, he did not attend the clinic and the patient was lost to follow-up.

Molluscum contagiosum
10–3. Molluscum contagiosum. Freezing with liquid nitrogen highlights central
umbilication.
 
 

Molluscum contagiosum
10–4. Molluscum contagiosum; confluent lesions of penis. Note bleeding after
expression of the core of a lesion.
  

REFERENCES
H. Hunter Handsfield, MD, Color Atlas & Synopsis of Sexually Transmitted Diseases, Third Edition.

COMMENTS

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CLINICAL ATLAS,118,DERMATOLOGY ATLAS,11,EMERGENCY ATLAS,44,HAEMATOLOGY ATLAS,23,HUMAN ANATOMY,1,MICROBIOLOGY ATLAS,66,PARASITOLOGY ATLAS,4,PATHOLOGY ATLAS,22,PEDIATRIC ATLAS,41,STDs,19,SUBCLINICAL ATLAS,116,
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Free Medical Atlas: [STDs] Molluscum Contagiosum
[STDs] Molluscum Contagiosum
These are the images, diagnosis and treatment of the disease caused by Molluscum Contagiosum. This is a Viral Sexually Transmitted Diseases.
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