Torn between Molluscum contagiosum and Gardasil vs. HPV

I was going to talk here about the 18yo female who had her Gardasil 3-shot series, before she had any sexual activity (per her report), and still ended up with an ASCUS PAP with HPV-having to discuss with her how there are over 100 HPV strains and the Gardasil only protects against 4 types and she still needed to use condoms or abstinence to decrease possible transmission of other HPV types.

However, a more interesting time with my preceptor was identifying and treating 2 patients with Molluscum Contagiosum. Each pt had c/o'd "bumps down there" that occasionally itched. Both pt's were worried they had genital warts. When examined, both pt's were "topiary" shavers and at first look by me, could have had folliculitis (barbae) pubis-from shaving genital hair off that then grew back and curled into the skin, or it could have been acne, or heat rash from my first glance. My preceptor quickly showed me the waxy, pinkish-flesh colored looking flat papules with a small central pit (umbilicated) that identified the "bumps" as molluscum contagiosum. In either case, the patients were told to stop shaving their genital area-to continue would increase spread of the molluscum.

Typically, the lesion of molluscum begins as a small, painless papule that may become raised up to a pearly, flesh-colored nodule. The papule often has a dimple in the center. These papules may occur in lines, where the person has scratched. Scratching or other irritation causes the virus to spread in a line or in groups, called crops.

The papules are about 2 - 5 millimeters wide. There is usually no inflammation and subsequently no redness unless you have been digging or scratching at the lesions. The skin lesion commonly has a central core or plug of white, cheesy or waxy material. In adults, the lesions are commonly seen on the genitals, abdomen, and inner thigh.

Molluscum contagiosum is a harmless virus but it may persist for months or occasionally for a couple of years. It frequently induces a type of dermatitis in the affected areas, which are dry, pink and itchy. Molluscum contagiosum may rarely leave tiny pit-like scars.

Non-medicine treatment- the infection can be cleared without medicine if there are only a few lesions as there were in our 2 patients at the clinic (each had less than 10 total). First, the affected skin area was cleaned with an alcohol swab. Next, a sterile angiocath needle was used to cut across the head of the lesion, through the central dimple. The contents of the papule (the central cheesy core) was removed with another alcohol swab. This procedure was repeated for each lesion (and is therefore unreasonable for a larger infections). With this method, the lesions would heal in two to three days. There was minimal pain with each molluscum core removed.

Lesions may resolve spontaneously without any treatment and without scarring within 6 to 12 months but may take as long as 4 years to completely disappear. Other treatment options include use of caustic chemicals (podophyllin, trichloroacetic acid, silver nitrate), lasers, and/or cryotherapy (liquid nitrogen). These options require a trained health care provider, may require local anesthesia, and can result in pain, irritation, and scarring. If every lesion is not removed, the condition may recur. Infected persons should return for reexamination one month after treatment so any new lesions can be removed. Sex partners should be examined for signs of infection as well.

Molluscum Contagiosum at a Glance

• Very common, contagious, benign skin disorder

• Caused by poxvirus

• Often seen in otherwise healthy people

• Commonly affects children and sexually active adults

• Typically on the trunk arms, and legs

• Looks like scattered, small, smooth tan or pink bumps

• Easily curable in most cases

• Sometimes clears on its own without treatment

• May require multiple treatments and ongoing maintenance therapy

• Often treated with freezing with liquid nitrogen

Prevented by good skin hygiene

http://lagunaskincenter.com/molluscum.aspx