Molluscum Contagiosum: What You Should Know

Andrew Siegel MD   10/30/2021

There are numerous skin diseases that may affect the genital skin and when confronted with a genital rash or skin abnormality, patients often initially consult a urologist.  Although every urologist has a basic knowledge of skin diseases, dermatologists are the true experts in this domain and when a patient presents to our office with an indeterminate genital skin lesion, he or she will readily be referred for a dermatology consultation. Some genital skin issues are unique to genital skin, but others like Molluscum Contagiosum (MC)–the topic of today’s entry– are more generalized skin problems that may involve the genitals.  

MC is caused by a poxvirus and is a common, self-limited viral skin infection spread by skin-to-skin contact. It most commonly occurs on the faces, trunks and limbs of children under 10 years of age. As a urologist, I see a few cases of the genital variety in adults every year.  It causes pearly appearing skin growths that are small (2-5 millimeters), raised, dome-shaped, smooth, firm, waxy and umbilicated (having a “belly button” or central depression) and are flesh or pink in color.

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At times, MC lesions can become itchy, tender or swollen. MC is generally a self-limited infection that usually disappears within 6-12 months. The poxvirus resides in only the epidermal layer of the skin, so once gone it does not remain in the body in a dormant state. However, it is entirely possible to become re-infected at a later time. Complications include secondary bacterial infections and scarring.

Transmission is via direct person-to-person contact and through inanimate objects (clothing, linens, toys, etc.) that become contaminated with the poxvirus. Many cases of MC in adults are spread by sexual activity, hence MC can be considered to be a sexually transmitted infection. Sexually transmitted MC may appear on the genitals, thighs, abdomen and anal regions.  It is often further spread by auto-inoculation (touching the lesion and then touching elsewhere) via scratching or shaving.

Risk factors include immunocompromised status, warm and humid climates, and sexually activity, although it may occur in sexually inactive individuals with intact immune systems and in any climate. With severe immunocompromise, e.g., HIV/AIDS, organ transplant, etc., there may be extensive eruptions of MC with larger and more numerous lesions that tend to be more resistant to standard treatments.

Treatment options include expectant management, physical removal and topical therapy. Expectant management is watchful waiting, allowing nature and time to resolve the infection. One needs to avoid sexual activity and maintain excellent hygiene, washing hands thoroughly, avoiding touching, scratching and picking the lesions, avoiding genital shaving, and avoiding sharing towels and personal items including soap.  Physical destruction of MC lesions is often done under local anesthesia via manual extrusion, freezing (liquid nitrogen) or curetting the core of the lesions and removing the cheesy inner contents. Although these methods will hasten the recovery, they can be painful and result in irritation, inflammation and possibly scarring. Topical therapy includes podophyllotoxin (Condylox), iodine and salicylic acid, trichloroacetic acid, potassium hydroxide, tretinoin (Retin-A), imiquimod (Aldara), and blistering agents.

Wishing you the best of health,

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro AreaInside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  He is the co-founder of PelvicRx and Private Gym.  His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. 

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health


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