Are These Asymptomatic Bumps Genital Warts?

These asymptomatic bumps developed on the groin area of a 16-year-old girl after her first sexual exposure.

(Answer and discussion on the next page.)

Answer: Molluscum contagiosum

This teenager had contracted molluscum contagiosum, B, a viral infection that can resemble warts. On close inspection, each lesion has a central umbilication, which distinguishes it from a wart.

HPV infection in women can cause genital warts, which should be considered in the differential. Bacterial folliculitis is typically tender and pustular. A milium appears as a deep whitehead–type comedone.

Molluscum contagiosum has 2 peaks of incidence¹:

• The first is in children, in whom transmission occurs from nonsexual skin contact.
• The second is in young adults (aged 15 to 29 years), in whom the infection is usually sexually transmitted.

Topical treatments include the following:

• Cantharidin: A single application that may need to be repeated once or twice every 3 to 4 weeks.
• Tretinoin cream (0.1%) or gel (0.025%): Applied daily until the lesions resolve.
• Imiquimod cream 5%: Applied daily until the lesions resolve.
• Trichloroacetic acid: A single application that can be repeated at 3 to 4 weeks as needed.
• Cryotherapy with liquid nitrogen.

REFERENCE:

1. Pannell RS, Fleming DM, Cross KW. The incidence of molluscum contagiosum, scabies and lichen planus. Epidemiol Infect. 2005;133:985-991.