Guidelines 2016 – Molluscum Contagiosum
Guidelines for Nurse Practitioners in Gynecologic Settings 2016
I. DEFINITION
Molluscum contagiosum is an infectious disease of the skin affecting the face, arms, genitals, abdomen, and thighs. It is caused by a virus and is seen in all age groups and in both sexes.
II. ETIOLOGY
A. Molluscum contagiosum virus, a member of the poxvirus family
B. Probably transmitted through direct skin contact, including sexual contact with an affected partner, and through contact with contaminated objects such as toys, doorknobs, and faucet handles
C. Incubation period: 1 week to 6 months (usually 2–7 weeks)
III. HISTORY
A. What the patient may present with
1. Fleshy growths (1–20), dome-shaped, waxy, or pearly white pap- ules with central caseous white core, primarily in genital area, but may be found on other body surfaces; may be 1 to 5 mm in diameter (but up to 15 mm), may be pedunculated; can be single or grouped
2. No other symptoms or complaints but occasional pruritus, tenderness, and/or pain
314 VAGINAL CONDITIONS
B. Additional information to be considered
1. Previous episode of similar lesions
2. History of STI
3. Sexual activity, last intercourse
4. Known contact
5. Method of birth control; other medications
6. Any drug allergies
7. HIV risk/exposure, especially with widespread lesions (100 or more)
IV. PHYSICAL EXAMINATION
A. Observe perineum for fleshy, usually papular, skin-colored lesions with indented centers that contain white, curdlike material
B. Observe any other involved body area
V. LABORATORY EXAMINATION
A. Visual examination
B. Skin scrapings under a microscope
C. Pathology report on crushed excised lesion using Pap smear, Wright, Giemsa, or Gram stain
D. Serology test for syphilis
E. GC culture/Chlamydia test
F. Further laboratory work as indicated by history
G. Consider HIV screen, especially with 100 or more lesions
VI. DIFFERENTIAL DIAGNOSIS
A. Genital warts (condylomata acuminata)
B. Herpes simplex
C. Pyogenic granuloma
D. Folliculitis
E. Small epidermal cysts
F. Closed comedones
G. Basal cell carcinoma
H. Furunculosis
VII. TREATMENT
A. Removal of lesion
1. Cytotoxic agents: TCA, BCA, podophyllin
2. Excision of lesions by curettage with topical anesthetic followed by application of silver nitrate
3. Destruction of lesions by cryotherapy; consider physician consult
4. Laser therapy
5. Topical 5% imiquimod daily for 5 days a week at bedtime
B. General measures
1. Return for weekly or biweekly evaluation and treatment until lesions have healed
2. Refer sexual partner(s) for evaluation
SYPHILIS 315
VIII. COMPLICATIONS
Secondary staphylococcal infection
IX. CONSULTATION/REFERRAL
A. For treatment as stated previously
B. Patients with extensive molluscum, lesions on face, or repeated recurrence after treatment should be reevaluated for HIV infection.
X. FOLLOW-UP
Return for reevaluation if lesions persist/recur after treatment
See Bibliographies.
Website: www.cdc.gov/mmwr/pdf/rr/rr5912.pdf