molluscum or herpes or???

[jjdog]

Doctor, I have read this forum extensively as well as much additional research on the internet in general. Based on my findings I feel I may have contracted Molluscum Contagiousm (excuse spelling) although fears of herpes or other stds still linger. I am a 32 year old hetero male who has been sexually active and have had unprotected sexual intercourse with 3 different females over the last year with the last occurring a couple of months ago. Approximately 6 weeks ago I noticed some small bumps on my lower abdomen which I initially dismissed as pimples or something of the like. About a week later I realized they were kinda sticking around and after closer inspection I realized there were several in the pubic region and general groin region. They look very much like the way MC is described….dome shaped papules which are light pinkish color with a whitish color within and some have the central dimple but others I cant tell as some are quite small. They are not clustered like they say herpes does and they have never bursts. They do not hurt and they have not changed in appearance in the last 5 to 6 weeks. Over the last several weeks I also noticed there were some very small papules on the under side of the head of my penis as well as a couple on the shaft. These have a consistent presentation but are even smaller and could almost be dismissed as normal variation but I’m pretty sure they were not there before. I have had no other symptoms other than last week I started having a very mild tingling sensation in the groin area and also a little on the head of my penis. This was very mild and perhaps seemed more significant due to my anxiety. Also over the last several days I have had some sensitivity in anus area….like the feeling of a very mild rash. I have inspected the area and cant see or feel anything but just experience this mild sensation. I read that it was common for MC to spread throughout the genital area, lower abdomen as well as the buttocks and butt crack. Does this all seem consistent with MC in your opinion.
1. Does this sound like MC?
2. What is the likelihood that this is herpes? Would herpes just present for this long and not ever change (blister-open-pain-scab).
3. Are there any other stds that have this presentation I should be concerned about.
4. How contagious am I? Will I pass this on to new partners whether protected or not as the bumps on my stomach are exposed and could obviously touch the other person when being intimate.
5.      Will this likely continue to spread? Its seemed pretty much the same over the last few weeks.
6. Should I have this treated or should I see if it just goes away on its own as these symptoms are pretty mild. I read it can take a while for them to go away.
7. What is your treatment of choice for MC assuming that’s what this is?
8. Any over the counter recommendations?
Thanks!!!!

[H. Hunter Handsfield, M.D.]

My main advice is to see a health care provider.  If not sure of your primary provider's expertise, visit your local health department STD clinic or a dermatologist.  It is a mistake to rely on your verbal description to me or any online source for a diagnosis.

1) Your description sounds like molluscum contagiosum is a good possibility, but I cannot speculate with any more certainty.

2) Your description is not at all like herpes.

3) This doesn't sound like any STD other than MC.

4) If you have MC, you are infectious as long as you have lesions and if the lesions come into contact with another person's skin.  The virus may also involve skin areas that look visually normal, so any sexual contact risks transmission.

5) The natural course of MC in adults has not been well studied.  My and others' clinical experience includes some cases that spread fairly widely before resolving, others that do not.

6) Eventually MC resolves spontaneously, but most providers recommend treatment to speed the process.

7) Treatments for MC include curetting (i.e., scraping off by a health professional, which is less painful than it sounds), electrocautery, or freezing.  Imiquimod (Aldara) often works, but is slower than the other methods.  

8) There are no OTC remedies that I know of.

To repeat the bottom line:  I reemphasize that I do not know that you have MC, and that you need to see a health care provider for diagnosis and treatment advice.

Regards--  HHH, MD

[jjdog]

Thanks for your prompt response doctor...much appreciated! I am planning on trying to see a dermitologist sometime soon. I am still a little confused about MC....some people seem to say its not really that contagious? If i recall correctly I read i post by Dr Rockoff on this site saying something to the effect "despite the name contagiosum its not really contagious". He also said  "Mollusca--which are usually not contracted from someone else, by the way--go away on their own, but they take 9 months on average, so most adults would rather have them treated. Mollusca can and often do come without any apparent source; in other words, they don't have to come from sex, or even from contact. They just appear." Whats your opinion on this? So i should avoid all contact with others untill all these little things are gone? Thank you so much for your feedback.

[H. Hunter Handsfield, M.D.]

I knew that someday someone would point out the differences between me and Dr. Rockoff about MC.  I'm not going to get into an online debate.  I'll just say that the STD literature makes it clear that MC of the genital area (including pubic area, lower abdomen) in adults generally is sexually acquired.  To quote from the chapter on MC in the main textbook on STDs (Holmes et al, McGraw-Hill, 1999):  "The suspicion that genital MC is sexually transmitted is supported by indirect evidence, including lesion location, a frequent history of contact with multiple sexual partners,...the presence of other STDs,...genital lesions in sexual partners, and peak ages of occurrence (20-29 yr) [as for]...other STDs."  (The chapter was written by Dr. John Douglas, now head of CDC's Division of STD Prevention.)

The differences in perspective might relate mostly to "genital area" infection.  There may be lots of cases in adults who show up in dermatologists' office and not STD clinics with MC involving other areas of the body.  Among all adults with MC, perhaps it is right that sex doesn't account for the majority of cases.  But the case seems pretty clear for genital area infection.

That said, I'm sure there are exceptions, some genital and lower abdomen cases not sexually acquired.  The main point is that such persons' sex partners should be examined; and people with genital MC should be routinely tested for other common STDs.  (Which is another reason you need to see a provider and not rely on self diagnosis and/or treatment.)

HHH, MD

HHH, MD

[Englishman]

Just to throw petrol on the fire, my GUM clinician expressed the view that it is not very contagious and rarely transmitted from genital to genital. I guess the wide ranging view is because of the uncertainty. There is very little in-depth information available on the net and that which does exist is contradictory.

[jjdog]

Thanks again for your feedback Doc...didnt mean to start a scholarly debate! I'm just glad that this doesnt appear to be herpes! I'm gonna go get checked out soon. Thanks again

[jjdog]

Ohh..one more thing. This question is open to anyone who knows the answer. If i go to my doctor and ask to be tested for stds which will i be tested for? (eg herpes, hpv, clymidia?) Do they test you for everything including HIV even if you dont ask? Just curious. Thanks

[Englishman]

When I went here in England, they showed me a list of STDs that they tested for and informed me about those that they do not routinely test for. They recommended tests based on information about my previous partners that I discussed with them.

[GuyEndora]

jjdog, thanks for your post and the insightful comments by the doctor. I too posted fairly recently and am printing out your question and the answers for my dermatologist to read as I'm fairly certain I too have Molluscum based on your description. Question: Did you notice the Molluscum clear up on it's own in an infected area and then re-appear 2-3 months later albeit maybe at a lesser degree?

I just placed an order for SilverCure tonight and hope this will help my condition.

Thanks again to all - this forum has been excellent.

[jjdog]

Guyendora, i had never had these symptoms untill 6 weeks ago or so. They have changed very little since i noticed they were spread around in the groin area. I have read other posts and info on the web which states it can come and go to some degree but it seems for most people who have them successfully treated they dont come back. What is this silver cure you mention? Is this a proven treatment? I am going to see my primary doctor tommorrow although i'm a little skeptical as it seems many primary docs arent really up on this virus. I want to get these little bastards off of me!

[GuyEndora]

http://www.molluscum.com/ for more information. SilverCure is available for those with molluscum.

What frustrated me to no end is that the molluscum always seemed to heal to a great degree and not be as pronouced so my family doctor, STD clinic doctor AND my derm all told me not to worry and let it clear up on its own. But it has recurred.

But now that i've seen more pictures of molluscum and read more posts, i'm fairly certain that's what I have. I'm taking pictures and printing pages from this website to bring to my derm.

[jjdog]

Good luck man...sounds like you have had a frustrating experience with this. I'm not sure what my primary doc will say or recomend but i may ash her to prescribe Imiqumod or whatever it its called...ardel? I have to look it up again. I guess i'll have to wait and see. I'll take a look at this silver cure...just hope its not one of those internet rip offs.

[jjdog]

Went to see my primary Doc today...said it definately looks like MC...she said it was a "classic presentaion". I asked her to take a swab to rule out herpes even though she felt pretty comfortable saying that it wasnt herpes. She prescribed Aldera and gave me some Derms to look up. I may just use the Aldera and maybe try the self removal method (needle and anticeptic).Again...thanks for this forum...its really helpful!

[steve123]

Sounds exactly like the Molluscum I have/had.  My first break out was like you described,  I removed them all myself (about 20 of them) That was 2 years ago.  I still get them from time to time but the amount and the frequency is dropping.  Maybe if I didn't drink like a fish they would have been gone a while back.  I know alcohol affects your immune system.   I haven't seen one for 4 months until this week and I had one pop up,  i got rid of it and it is almost healed.

Here is what I do to get rid of them if you are curious:

swab the area with alcohol as well as any "tools" you are using
Get a needle, cotton balls, tweezers, and that "New Skin" stuff.  Slightly ***** the top of one,  just enough to break the skin,   Sqeeze it like a pimple and hopefully the core will come out some, It is white and looks like a seed.  Grab it with the tweezers and then wash it down the sink.  The tweezers and needle will be contagious at this point so don't touch any other part of your body with them until you can put them in alcohol again. Once the core is removed it will bleed heavily for about 10 minutes,  just keep a cotton ball on it and once it stops bleeding,  apply New Skin to the lession.  Leave that one for a few days.   If done right you shouldn't have any other bacterial infections and it will heal up pretty quick.

They aren't hard to get rid of.  Although for an initial outbreak,  you might want to just go to the derm and have them frozen off or whatever they do there.  Having to removed a large number of them at once is kind of nerve racking,  especially the more sensitive areas.  The above instructions are more for routine maintainance.

[jjdog]

thanks for your feedback steve 123! I'm not sure what method i will use at this point...maybe a little of both. I'll probably at least do the self removal method on a few and see how it goes.

[Englishman]

IMO freezing is not worth it - the scars take about 6 weeks to disappear. The self-removal method works best and heals the quickest. I find that sueezing them between the fingernails works fine - disinfect the area, use a tissue to stop the bleeding (takes about 2 minutes), keep the area dry and it will fully heal in about 3 days (as opposed to six weeks for freezing!). Best of luck.

[jjdog]

hi englishman...thanks for your feedback and advice. I will give the self removal a try and use the aldera too. So you think that the finger nails is more advantageous than a needle?

[Englishman]

http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=250&sectionId=13775

This is the advice here in the UK from the National Health Service.

I did'nt bother with the latex gloves, I just washed my hands in antiseptic. I would'nt bother with Aldara neither if you have to pay for it, I've heard that it can irritate and discolour the skin. Mine were individual descreet lesions (no more than 10 at a peak - about 4 months ago). Most have gone, occasionally one pops up, I leave it to mature, then when it looks ready for the picking, give it a squeeze between the nails and I make sure all the core comes out. Bleeds heavily but stops easily within a minute or so. Freezing was a pain in the *** (or penis I should say) and definitely not worth the hassle. Best of luck.

P.S. Waiting for them to mature a bit is useful in case you start squeezing cysts or something else - make sure they are the molluscum.

[Englishman]

P.S. The silver MC cure is a blag. MC clears up by itself anyway. People using these remedies and think that they are responsible for the clear up. Same goes for half the wart remedies. They are there to make money out of people, nothing more, nothing less. Don't give them your hard-earned cash.

[Englishman]

P.S. According to the NHS, most people are resistant to catching molluscum which is what my health care provider said. There is a dichotomy over this but I was told I need not bother stopping having sex. I decided to wait a little anyway.

[H. Hunter Handsfield, M.D.]

The NHS is right; most people probably are resistant to MC.  Most of us probably get it as toddlers (often unknown) and then are immune.  That is, most likely it is the minoirty who escape childhood infection who catch MC sexually as adults.

If done antiseptically, needle plus expressing the core is effective--and much quicker than Aldara, by the way.  I didn't recommend it because I don't make such specific treatment recommendations on line, and for safety against secondary infection I normally recommend this approach only for people shown how to do it by a knowledgeable provider.  However, I sometimes do that in the clinic, after freezing lesions--in case freezing doesn't work or if new lesions appear afterward.  Successful expression of the entire core is indicated by brisk bleeding that can take a few minutes to stop.

Doing it safely means alcohol; a different sterile needle (or flame sterilized needle) each time; latex gloves to prevent autoinoculation to hands and then to other body parts; and careful disposal of said gloves.

HHH, MD

[jjdog]

Thanks everyone for the feedback and to the Doctor for continuing to follow the thread! I just went ahead and got the script for aldera since i was there and it was pretty cheap with my insurance so at least i have it just incase i want to give it a go. What type of alchohol should i use...just basic rubbing alcohol?

[Englishman]

I use TCP. It is halogenated phenol. Any strong antiseptic should do the trick. Check with any doctor if the doc here doen't answer. Good luck.

[steve123]

I prefer a needle to using fingernails,  Just a small ***** to break the skin,  make the core easier to come out.  Squeezing seems to potentially cause damage to the skin which will make the whole area red for a few days.  My most recent one I got monday was about 2mm across,  I removed it tuesday,  I can barely see it on my skin now.   I noticed 2 other smaller ones near the big one,  I just put alcohol and then new skin on them and they just disappeared.  Not sure what happened there,  maybe the antiseptic soaked in and killed it or maybe my body just got rid of it.

I've heard reports that it is highly Contagious and I've heard others that say it isn't.  I think from what I have seen.  It is highly Contagious if you are a child.  As an adult,  you have a better immune system usually or have already gotten it as a kid.  But needless to say,  I got mine 2 years ago and I'm in my 30s so anything is possible.

[Englishman]

Dunno why the previous post was censored.

[Englishman]

I've got it P R I C K. Whats the point in censoring that in the above context? Must be an automatic filter.

[jjdog]

So...its been another wek or two since going to the doctor. She took a swab of one of the sores and it came back negative for herpes which i was thankful. As i said earlier in this post she said it looked like classic MC. I have been using aldera for a couple of weeks now about every other day. So far i'm not seeing any difference. Maybe i should just have them removed by a Derm?

[stevewynn]

A related discussion, NEED HELP FAST! Read the first post on this string was started.