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!