Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 13 Sept 2026Clinical review pending
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Extensive disease with severe immune compromise
Giant, confluent, facial or disseminated molluscum can mark advanced immune suppression, while painful erythema, fever or rapid tissue change suggests bacterial infection or another diagnosis.
Action: Assess systemic illness and immune status, test for HIV with consent, treat bacterial complications, and obtain urgent sexual-health, dermatology or HIV specialist review rather than repeatedly destroying lesions.
Synopsis
Recognise characteristic genital molluscum, distinguish warts and dangerous mimics, explain self-resolution, and select treatment safely in pregnancy, dermatitis and immune suppression.
Genital molluscum produces discrete, smooth, firm pearly or flesh-coloured papules with a central umbilication.
Diagnosis is usually clinical; dermoscopy or biopsy is reserved for atypical, giant, ulcerated, pigmented or uncertain lesions.
Offer routine STI screening to adults with genital disease and offer HIV testing when lesions are extensive, facial, giant or refractory.
Key red flags
Numerous giant, confluent or facial lesions in an adult warrant assessment for advanced HIV or another cause of immune suppression.
A pigmented, ulcerated, indurated, painful or bleeding lesion is atypical and requires reconsideration or biopsy rather than presumptive treatment.
Spreading erythema, purulent discharge, fever or severe tenderness suggests secondary bacterial infection rather than uncomplicated molluscum inflammation.
Periocular lesions or lesions immediately adjacent to a mucosal opening need specialist treatment to avoid ocular or structural injury.
Genital lesions in a child require a careful paediatric and safeguarding assessment without assuming a sexual route from the diagnosis alone.
Advanced immune phenotype
Large, confluent, numerous or facial lesions in an adult point to impaired cellular immunity.
Atypical solitary lesion
Pigmentation, ulceration, bleeding or induration requires biopsy consideration for tumour or another infection.
Investigation priorities
01
Whole-site clinical examinationFirst step
Confirm characteristic umbilicated morphology and map external genital, pubic, perianal and adjacent lesions.
Management branches
Worked caseConfirm then offer observation
A healthy adult has several painless umbilicated papules confined to external pubic skin.
Inspect the complete affected region with consent and verify classic morphology without ulceration, pigment or induration.
Offer site-specific STI testing and explain that adult genital disease is often sexually acquired but cannot date transmission.
Key medicines
Podophyllotoxin for selected external lesionsApply the licensed 0.5% preparation only to suitable visible external lesions on the guideline-directed cycle after clinician instruction.Avoid in pregnancy, internal mucosa and uncertain lesions; limit treated area and stop for severe erosion or systemic symptoms.
Mild topical corticosteroid for dermatitisApply a thin layer of a low-potency corticosteroid once or twice daily for a short course to eczematous surrounding skin.Do not apply indiscriminately to infected broken skin or use potent steroid on genital tissue without specialist assessment.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 13 Sept 2026; clinical approval remains outstanding.