Definitions of the levels of evidence (I-IV) and grades of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
Diagnosis
- This is usually based on characteristic clinical appearance.
- The main differential diagnosis is with genital warts, which are neither smooth nor umbilicated.
- The core of lesions can be examined by electron microscopy, under which typical poxvirus-like particles will be seen.
Management
General Advice
As the natural history is of spontaneous regression of lesions, treatment is offered for cosmetic reasons only.
Further Investigation
- As other sexually transmitted infections (STIs) may co-exist; a full screen for these should be undertaken (Level of evidence III, Grade of recommendation B).
- Human immunodeficiency virus (HIV) testing is recommended in patients presenting with facial lesions (Level of evidence III, Grade of recommendation B).
Treatment
The aim is tissue destruction, with viral demise accompanying this. There are no medicines licensed for the treatment of molluscum contagiosum (MC) in the United Kingdom (UK).
Recommended Regimens
- Cryotherapy – apply liquid nitrogen until a halo of ice surrounds the lesion. Repeat applications may be necessary (Level of evidence IV, Grade of recommendation C).
- Expression of the pearly core, either manually or using forceps (Level of evidence IV, Grade of recommendation C).
- Piercing with an orange stick, with or without the application of tincture of iodine or phenol (Level of evidence IV, Grade of recommendation C).
- Curettage or diathermy may be carried out under local anaesthesia (Level of evidence IV, Grade of recommendation C).
- Podophyllotoxin cream (0.5%) can be self-applied in men (Level of evidence Ib, Grade of recommendation A).
- Imiquimod 5% cream can be self-applied in men (Level of evidence Ib, Grade of recommendation A).
- In patients with HIV infection, the introduction of highly active antiretroviral therapy may lead to the resolution of lesions (Level of evidence III, Grade of recommendation B).
Allergy
- Treatments to which there is known hypersensitivity should be avoided
Pregnancy and Breastfeeding
- Cryotherapy and other, purely destructive methods are safe.
- Podophyllotoxin is contraindicated. The British National Formulary advises that Imiquimod should be used with caution.
Sexual Partners
- Contact tracing of partners is unnecessary
Definitions:
Levels of Evidence
Ia: Evidence obtained from meta-analysis of randomised controlled trials
Ib: Evidence obtained from at least one randomised controlled trial
IIa: Evidence obtained from at least one well designed controlled study without randomisation
IIb: Evidence obtained from at least one other type of well designed quasi-experimental study
III: Evidence obtained from well designed non-experimental descriptive studies such as comparative studies, correlation studies, and case control studies
IV: Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities
Grading of Recommendations
A (Evidence levels Ia, Ib)
- Requires at least one randomised controlled trial as part of the body of literature of overall good quality and consistency addressing the specific recommendation.
B (Evidence levels IIa, IIb, III)
- Requires availability of well conducted clinical studies but no randomised clinical trials on the topic of recommendation.
C (Evidence level IV)
- Requires evidence from expert committee reports or opinions and/or clinical experience of respected authorities. Indicates absence of directly applicable studies of good quality.
