Extensive genital molluscum in HIV / immunosuppression after first-line therapy has not achieved clearance

This protocol addresses people living with HIV or otherwise immunosuppressed who have extensive genital molluscum contagiosum lesions that have not resolved despite first-line treatment.

First-line therapy — failure condition

Liquid nitrogen (cryotherapy) or topical podophyllotoxin 0.5% are the recommended first-line options for genital molluscum lesions in people living with HIV. This protocol applies when those treatments have not achieved clearance or resolution of the lesions.

Next step — partial overview

For immunosuppressed patients with HIV and extensive genital molluscum lesions that persist after first-line treatment, the recommended next management step involves addressing the underlying immunosuppression directly. The complete regimen, sequencing, and decision criteria are in the full protocol.

Treatment goal

Resolution of extensive genital molluscum lesions.

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References

DOI: 10.1177/09564624211070705

We suggest that where active treatment is required, similar to immunocompetent individuals, liquid nitrogen and podophyllotoxin remain the first-line treatment options for genital lesions in people living with HIV.

For patients who are immunosuppressed (with HIV infection) and have extensive genital molluscum lesions, the introduction of active antiretroviral treatment will speed resolution, and we recommend that this should be regarded the most effective management option.

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