Warts/molluscum diagnosis

[gary38]

In March 2005, I was first diagnosed by a urologist as having a genital wart.  I had one recurrence later in 2005 and another recurrence in Jaunary 2006 both treated by the urologist.  

In June 2007 I noticed two small bumps on the base of my penis.  The week before I noticed the bumps I had gone to a massage parlor where I received a hand job but she was naked and there may have been some very brief genital contact. The urologist  diagnosed them as warts although remaked that they were very small ones.   He also tested me for clamydia, ghonorrea, syphilis, and hiv.  All tests came out negative.  

In September 2007 I dated someone new and had unprotected sex. At the end of the month I noticed two small bumps on the base of my penis and one bump on my scrotum  She said that I was the first person she had unprotected sex with since her last round of negative std tests.

When I went to get the new bumps treated, the urologist told me that he thought they were not warts but rather molluscum.    He referred me to a dermatologist who could be sure.  When asked if he thought it was possible that he had misdiagnosed the June 2007 episode as warts since from a timeline perspective it seemed they were more likely molluscum than warts,  he said that he hadn't noted any uncertainty in his chart in June 2007 but couldn't be sure The dermatologist confirmed molluscum.  

My questions (finally) are:

Do you think it's likely that the June 2007 warts were misdiagnosed?
If misdiagnosis is not likely and I did have warts in June 2007, is it possible that  I got the molluscum from the massage parlor even though the bumps didn't appear until three months later?  
Is it likely that I am still contagious for HPV even though I have had (at most) one episode since January 2006?
Given my history of STDs, is it important that I get tested for HSV as well?

Thank you very much for all of your help.

[H. Hunter Handsfield, M.D.]

The advice by the 2 doctors who have directly examined you would be much more accurate than anything I can guess; they have examined you directly and I have not.  However, molluscum contagiosum is self-curing within a few months, so it is unlikely that the earlier problem was MC.  But you could ask the urologist how certain he was about the warts diagnosis back then.

Molluscum contagiosum of the genital area is not well understood.  Most cases probably are sexually acquired.  It is unlikely that it can be transmitted by a hand job, but since no research has been done, I cannot say it is impossible.  But it is far more likely you caught it by vaginal sex with your new partner last month; the timing (seems like somewhere around 2-4 weeks) is right.  She should be examined for MC (and tested for other common STDs) if that hasn't yet been done.

Most people with genital warts probably are no longer contagious once a few months go by after the last treatment, with no recurrence.  But sometimes it is possible, and nobody can say for sure that you cannot transmit HPV to a partner.  But the chance is low.

There is no clear answer about HSV testing.  Some experts would say definitely yes, others definitely no.  I'm in the middle.  Most likely if you test, you will be negative for HSV-2 and a 50:50 chance you're positive for HSV-1.  However, almost a quarter of the population has genital HSV-2 without symptoms.  If you test positive, it will have nothign to do with the genital lesions you describe; they sound nothing like herpes.  If negative for HSV-2, you will know for sure you don't have genital herpes.  Anyway, it's your call.

Best wishes--  HHH, MD