Molluscum and Herpes Flashcards
What’s molluscum contagiosum?
- common skin infection caused by molluscum contagiosum (Pox family)
- epidermal eruption of the skin is caused
How is Molluscum Contagiosum Virus (MCV) transmitted?
- direct: by close personal contact (including sexual transmission), swimming pools etc
- indirect: via contaminated surfaces (e.g. towels)
What is the most common group of patients with Molluscum Contagiosum?
- majority of cases occur in children (often in children with atopic eczema)
- the maximum incidence in preschool children aged 1-4 years
What’s the location of molluscum contagiosum lesions in children?
- trunks
- flexures
- occasionally anogenital lesions
What’s the location of molluscum contagiosum in adults?
As often spread by sexual contact:
- genitalia
- pubis
- thighs
- lower abdomen
*rarely on oral mucosa or on the eyelids
What is self-care advice in molluscum contagiosum infection?
Reassure people that molluscum contagiosum is a self-limiting condition.
- spontaneous resolution usually occurs within 18 months
- the lesions are contagious → it’s sensible to avoid sharing towels, clothing, and baths with uninfected people (e.g. siblings)
- encourage people not to scratch the lesions
- exclusion from school, gym, or swimming is not necessary
How to diagnose molluscum contagiosum ?
By clinical appearance
Treatment of molluscum contagiosum
*Treatment is not usually recommended
- Treatment may be required if:
- → Itching is problematic -> prescribe an emollient and a mild topical corticosteroid (e.g. hydrocortisone 1%)
- → The skin looks infected (e.g. oedema, crusting); prescribe a topical antibiotic (e.g. fusidic acid 2%)
- cryotherapy
Other treatments that may be used: podophyllotoxin, imiquimod
In what cases do we need to refer people with molluscum contagiosum infection?
- people who are HIV-positive + extensive lesions → urgent referral to HIV specialist
- if eye-lid margin or ocular lesion or red-eye → urgent referral to an ophthalmologist
- adult with anogenital lesion → GUM referral (to screen for other STIs)
What’s that?
Molluscum Contagiosum
What’s that?
Genital Herpes
What organism caused Genital Herpes?
Herpes Simplex Virus (HSV)
What types of HSV cause genital herpes? (2)
- HSV-1 → genital herpes, mouth, nose (cold sores)
- HSV-2 → genital and anal areas
How is Herpes Simplex Virus transmitted?
- via small cracks in the skin
- through mucous membranes (mouth, vagina, rectum, urethra, under the foreskin)
What happens after HSV enters the skin?
Skin infection → virus travels to the ganglion of the nearest nerve and remains there
(therefore virus can be dormant in the nerve -> then travels back to the skin surface when reactivated)
Risk factors for Herpes infection
- sexual transmission (een when condom is used if the virus is present on the areas that are not covered up e.g. thighs)
- multiple sexual partners
- oral sex with a partner suffering from cold sores
When do the symptoms of Herpes appear?
- symptoms may not appear for months or even years after infection
- some people will develop symptoms straight away
What is the presentation of the primary HSV genital infection?
Primary = when HSV infection develops for the first time
- small red, painful blisters around the genitals
- open sores may be formed
- vaginal or penile discharge
- flu-like symptoms (fever, maliase, muslce ache)
- itchy genitals
In aroudn 20 days the lesions will crust and heal
Features of secondary HSV infection
Secondary = recurrent (when dormant virus reactivates)
- burning and itching around genitals
- painful red blisters around the genitals
*secondary infections tend to be less severe and shorter as immune system develops antibodies that will enable for more effective immune reesponse
Investigations for genital herpes
- history -> sexual history, other STIs, Hx of cold sores
- swab from the open sore -> PCR testing
Management of primary Herpes infection
- Aciclovir -> anti-viral medication
(to reduce size and number of the lesions)
- a full sexual screen and advice on transmission -> once a primary infection has cleared up
- rest, time off work if unwell
What advice about sexual transmission to give to people with Herpes infection?
- advice about preventing transmission of the infection to sexual partners – avoid all sexual contact during an outbreak, as the open sores are the most infective form of HSV
- disclose the infection to their recent and current sexual partners
Management of recurrent (secondary) Herpes infection
To reduce pain and discomfort:
- OTC painkillers
- petrolleum jelly
- ice packs
What if a woman infected with genital herpes becomes pregnant?
- baby should be protected from acquiring the infection due to the antibodies she will pass to the foetus through the placenta
- may be required to still take Aciclovir
- Vaginal delivery is offered to women with recurrent lesions at time of delivery although they may want to have a caesarean section
(The risk of transmission is estimated at 0-3% transmission with vaginal birth)
