What are the treatment options for molluscum contagiosum on the penis?

Treatment of Molluscum Contagiosum on the Penis

For molluscum contagiosum on the penis, cryotherapy with liquid nitrogen is the recommended first-line treatment due to its high efficacy rate of 93.3% complete response. 1, 2

Treatment Options

First-Line Treatments:

1. Provider-Administered Treatments:

   • Cryotherapy with liquid nitrogen:
     • Apply every 1-2 weeks until lesions resolve 3
     • Highly effective with 93.3% complete response rate 1, 2
     • Caution: May cause pain, necrosis, blistering, and potential post-inflammatory hyperpigmentation 3

2. Patient-Applied Treatments:

   • 10% Potassium hydroxide (KOH):
     • Apply twice daily until lesions resolve 4
     • 86.6% complete response rate 4
     • Less expensive with better cosmetic results than cryotherapy 4

Alternative Treatments:

1. Surgical options:

   • Curettage or excision for immediate removal of lesions 3, 1
   • Tangential scissor excision or shave excision 3
   • Electrosurgery for larger lesions 3

2. Chemical treatments:

   • Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80%-90%:
     • Apply small amount to warts until white "frosting" develops 3
     • Can be repeated weekly as needed 3
     • If excess acid is applied, neutralize with talc, sodium bicarbonate, or liquid soap 3

3. Podophyllin resin 10%-25% in compound tincture of benzoin:

   • Apply thin layer and allow to air dry 3
   • Can be repeated weekly if necessary 3
   • Limit application to <0.5 mL or area <10 cm² per session 3
   • Consider washing off after 1-4 hours to reduce irritation 3

Important Considerations

1. Imiquimod is not recommended:

   • FDA label specifically states that studies in children with molluscum contagiosum failed to demonstrate efficacy 5
   • Not more effective than placebo according to randomized controlled trials 1

2. Evaluation for immunocompromised state:

   • Consider in adults with large and multiple lesions 1
   • Immunosuppressed patients may develop severe and recalcitrant lesions requiring specialized treatment 6

3. Prevention of transmission:

   • Cover visible lesions with clothing or bandages when possible 1
   • Maintain good hand hygiene, especially after touching lesions 1
   • Avoid sharing personal items like towels and clothing 1
   • Avoid scratching or picking at lesions to prevent autoinoculation 1
   • Avoid intimate contact until lesions resolve 1

4. Follow-up:

   • Regular monitoring every 1-3 months to assess progression 1
   • Identify and treat nascent lesions to reduce recurrence risk 1

5. STI screening:

   • Patients with genital molluscum contagiosum should be offered screening for other sexually transmitted infections 6

Treatment Algorithm for Penile Molluscum Contagiosum

1. For limited lesions (fewer than 10):

   • Cryotherapy with liquid nitrogen every 1-2 weeks
   • Alternative: TCA/BCA 80-90% application weekly

2. For extensive lesions (more than 10):

   • Cryotherapy for larger/prominent lesions
   • Consider patient-applied 10% KOH for smaller lesions
   • May require combination of approaches

3. For recalcitrant lesions:

   • Consider surgical removal options
   • Evaluate for underlying immunocompromised state

4. For painful lesions:

   • Consider local anesthesia before cryotherapy 3
   • TCA/BCA may be less painful than cryotherapy

Remember that treatment may require multiple sessions, and the choice of treatment should be based on the number and location of lesions, as well as patient preference and tolerance to pain.