MC is usually self-limiting and spontaneously resolves after a few months in immunocompetent hosts. In the setting of advanced HIV immunodeﬁciency, the recalcitrant lesions often improve with immune reconstitution on ART. Genital lesions should be deﬁnitively treated to prevent spread by sexual contact. General advice about the risks of autoinoculation and spreading should be given, such as avoiding waxing or shaving areas with active lesions, instructing patients about not to share clothing or towels, and explaining that condoms may reduce the risk of transmission, but are not absolute. Most common alternatives are curettage, cryotherapy, derooﬁng the lesions, or laser therapies to remove individual lesions. Topical therapies include: cantharidin (single application that may need to be repeated); tretinoin cream (0.1%) or gel (0.025%) daily; podophyllin; trichloroacetic acid; imiquimod applied under occlusion; silver nitrate or phenol. Topical cidofovir, although expensive, may be useful in recalcitrant disease.
New lesions or inﬂammation of existing MC lesions may appear in the context of IRIS before disappearing with restored immune function.