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Sexually transmitted infections

Molluscum Contagiosum Treatment

Treatment

Genital lesions should be definitively treated to prevent spread through sexual contact. New lesions that were too small to be detected at the first examination may appear after treatment and require attention at a subsequent visit.

Curettage

Small papules can be quickly removed with a curette with or without local anesthesia. Bleeding is controlled with gauze pressure. Curettage is useful when there are a few lesions because it provides the quickest, most reliable treatment. A small scar may form; therefore, this technique should be avoided in cosmetically important areas. Lidocaine/prilocaine (EMLA) cream applied 30 to 60 minutes before treatment helps prevent the pain of curettage for children.

Cryosurgery

Cryosurgery is the treatment of choice for patients who do not object to the pain. The papule is sprayed or touched lightly with a nitrogen-bathed cotton swab until the advancing, white, frozen border has progressed down the side of the papule to form a 1-mm halo on the normal skin surrounding the lesion. This should take approximately 5 seconds. A conservative approach is necessary because excessive freezing produces hypopigmentation or hyperpigmentation.

Imiquimod

Several small studies suggest that the immune response modifier imiquimod 5% cream, brand name Aldara is effective treatment. Patients as young as 1 year of age have been treated. Dosing frequency varies from once daily to three time each week. The drug is well tolerated. Local side-effects include erythema, itching, burning sensations and pain.

Imiquimod is most efficacious in patients with HIV-1 disease and in the genital area in immune-competent adults.

Cantharidin

Cantharidin is a safe and effective therapy. A small drop of Cantharone (cantharidin 0.7%) is applied over the surface of the lesion, while contamination of normal skin is avoided. Temporary burning, pain, erythema, or pruritus may occur. Secondary bacterial infection does not occur. Lesions blister and may clear without scarring. New lesions occasionally appear at the site of the blister created by cantharidin. An alternate method is to apply a tiny amount of cantharidin and cover the area with tape for 1 day. The resulting small blister is treated with Polysporin until the reaction subsides.