Genital Molluscum contagiosum
Molluscum contagiosum, also known as “water warts” or “mollusca”, is a benign skin condition caused by infection with the Molluscum contagiosum virus (MCV) that commonly occurs in children.
It causes raised spots on the skin and is spread primarily by skin-to-skin contact. It is generally harmless, doesn’t require any specific treatment, and usually disappears on its own.
Antibodies to Molluscum contagiosum virus were found in over 30% of people in a small representative sample of healthy adults in the UK in a small study published in 2014, suggesting that exposure to this virus is relatively common and that not all those exposed will get symptoms.
Treatment
We offer effective treatment (from Hyfrecation) for Molluscum in all locations.
Symptoms
Small clusters of small, firm, raised spots with a white dimple in the middle.
Diagnosis
Routinely diagnosed from a physical examination from a trained clinician.
Causes
Molluscum can spread from close contact, sharing of infected items and sex.
What are the symptoms of Molluscum contagiosum?
The main symptoms of Molluscum contagiosum are small clusters of small, firm, raised spots known as mollusca that appear on the skin. These lesions are usually round in shape, with a characteristic small dimple in the middle. They are typically pink or red, around 2–5mm in size, and appear smooth and shiny, like pearls. They are not painful, although they can sometimes be itchy.
Mollosca can appear anywhere on the body; however, in children, they tend to appear around the face, neck, chest, arms or legs. In adults, they typically appear around the genitals, anus, groin, buttocks, abdomen or thighs. Lesions are rarely found in the mouth, on the soles of the feet or palms of the hands.
When do symptoms of Molluscum contagiosum typically occur?
The time from exposure to an infectious agent to exhibiting symptoms is known as the incubation period. For Molluscum contagiosum, the incubation period is typically 2–8 weeks; however, lesions can appear as soon as one week after exposure or may take up to six months to appear.
Can I have Molluscum contagiosum without any symptoms?
Infection with the Molluscum contagiosum may occur without the characteristic lesions. Research has shown that there are people who have antibodies to the molluscum virus, but who have no recollection of ever having mollusca. In addition, some people who have acquired molluscum lesions sexually cannot recall the presence of such lesions in their sexual partners.
In some cases, the lesions may be very small or subtle and may be missed unless a trained healthcare professional carefully examines the entire surface of the skin.
What are the complications of Molluscum contagiosum?
Molluscum contagiosum rarely causes complications and is generally harmless. In some cases, if the lesions become infected with bacteria (particularly if they have been picked or scratched). A bacterial infection may require antibiotic therapy.
There is also a risk of scarring, particularly if they become infected, or if treatment is employed.
Local irritation or eczema may occur around the mollusca in about 10% of cases.
What are the risk factors for more severe forms of Molluscum contagiosum?
Certain individuals are at greater risk of more severe Molluscum infection. This may include a greater number of spots, a slower healing time, or frequent recurrence. People at greater risk of this include those with HIV, those with underlying skin conditions such as eczema, and those taking immunosuppressive drugs such as chemotherapy.
What causes Molluscum contagiosum?
Molluscum contagiosum is a pox virus that can be spread through;
- Close direct contact and touching the skin of the infected person, this includes things like contact sports
- Touching contaminated objects belonging to the person such as towels, flannels and clothes
- Sexual contact, including sexual intercourse
- Once you are infected, you can spread the virus to other areas of your body. Picking, scratching or squeezing the lesions increases the risk of transmission as the substance inside the spots is highly infectious and spreads easily.
Molluscum is not transmitted via sneezing or coughing, as the virus resides on the skin rather than in respiratory secretions like the common cold viruses.
Who can get infected?
Children often get infected due to using a contaminated item of personal hygiene such as towels, whilst adults tend to get these lesions around the genitals due to intimate or sexual contact. Some instances of transmission are suspected to occur in the settings of social activity such as swimming pools, sports venues and gymnasium.
It is difficult to be sure how and when one got the infection in most cases. The occurrence of lesions in the genital areas of sexually active individuals is likely to be due to sexual transmission.
Who is at a higher risk of getting Molluscum contagiosum?
- People with a partner who has Molluscum contagiosum
- Children between the ages of 1–10
- Those who live in a tropical climate
- People with weakened immune systems (such as those with HIV or cancer)
- Those with atopic dermatitis (eczema)
- People who participate in contact sports or swimming
How does it spread from one person to another?
MCV is a contagious virus, which is passed from one person to another by close social contact, intimate sexual contact, as well as through coming into contact with contaminated items of personal use such as towels.
In real life, the virus spreads by a combination of the above mechanisms in the community. For example, a person may get the infection from close sexual contact, and may contaminate a towel that a family member subsequently uses.
Can I pass Molluscum contagiosum to my partner?
It is possible to pass the infection onto your partner through skin-to-skin contact or via sexual contact. For lesions on the body, avoid picking or squeezing them, as this releases a highly infectious substance that can easily be transferred to a partner.
Where Molluscum contagiosum lesions appear on the genitals, this can lead to spread to sexual partners. Using a condom can help prevent transmission, but may not completely eradicate the risk if lesions are not entirely covered.
Is Molluscum contagiosum an STI?
Molluscum contagiosum can be transmitted via skin-to-skin contact or sexual contact. In adults, lesions often appear on or near the genitals, and the virus is therefore passed on when engaging in sexual activity.
Although it can be transmitted through sexual contact, it is not generally considered a sexually transmitted infection due to its ability to spread via simple skin-to-skin contact with an infected individual.
If you think you may have contracted Molluscum from a sexual partner, it’s advisable to have a full sexual health screen for other STIs such as Chlamydia and Gonorrhoea.
How is Molluscum contagiosum diagnosed?
Molluscum contagiosum can be diagnosed clinically in over 99% of cases. This means a trained healthcare professional familiar with the condition will take a history and examine your skin and will be able to provide a diagnosis without needing any additional investigations or tests.
What factors can help a correct diagnosis?
It is important to know the history of the lesions, so you will be asked if you remember how they started, how long they have been there, and if their appearance has changed over time. You will also be asked if you recall being in contact with anyone with similar skin changes. Your clinician might also ask you other questions about your lifestyle and habits to help assess your risk of having Molluscum contagiosum.
A detailed and thorough examination of the entire skin surface using a good light source is key to providing an accurate diagnosis of any skin condition. If using photography to aid in diagnosis without physical examination, high-quality and well-lit photographs are helpful. It may also be helpful to photograph the lesions over time, to allow for assessment of evolution and to rule out other skin conditions.
Is there any other way to diagnose Molluscum contagiosum?
In some circumstances, your clinician may be able to diagnose you based on your history alone, without examining you. In this case, the clinician may ask you to send a photograph of the lesions to make a diagnosis. In some cases, the lesions may be viewed under magnification using a magnifying glass or dermatoscope to give a more detailed view. Examination after freezing can also be useful, as this process produces a transient contrast, making the characteristic central punctum easier to identify.
If there is a diagnostic uncertainty, or any concern about precancerous or cancerous changes in the skin, then a skin biopsy may be recommended. This is where a sample (biopsy) of the abnormal skin is taken under anaesthetic and sent to a laboratory for examination under a microscope. It may take a number of weeks for the results of a biopsy.
It is possible to use molecular testing to identify the genetic material of the Molluscum contagiosum virus using a polymerase chain reaction (PCR). This test amplifies the DNA of the virus to a point where it is visible using a special testing platform. This is rarely used in practice, however may be useful in cases where the diagnosis is uncertain and lesions may be caused by another infective agent such as herpes simplex virus (HSV) or human papillomavirus (HPV).
PCR testing can be helpful to identify which type of molluscum virus is present. MCV 1 is the commonest type and causes most of the cases in children. MCV-2 is mainly responsible for skin lesions in people living with HIV. MCV-3 and MCV-4 are very rare. Some patients have more than 1 type of virus detectable in their lesions.
What is an MCV antibody?
When someone gets infected with the Molluscum contagiosum virus (MCV), their body produces antibodies against the virus via their own immune system’s response. Antibodies generally develop whether one gets any symptoms or not, and this antibody remains detectable in the blood for a long time. MCV antibody testing is not routinely available and has only been used in healthy populations to study the seroprevalence of this virus.
What is the difference between Genital warts and Molluscum contagiosum?
Genital warts and Molluscum contagiosum are caused by different viruses. Genital warts are skin outgrowths caused by one of the strains of the human papillomavirus (HPV) family, most commonly types 6 and 11, whereas Molluscum contagiosum is caused by the Molluscum contagiosum virus (MCV). Genital warts typically appear more “cauliflower-like” with an irregular shape, and tend to be more soft and fleshy than MCV lesions, which are round, flatter and more firm, with a characteristic central spot.
Can another infection be mistaken as Molluscum contagiosum?
In the diagnosis of Molluscum contagiosum, it is important to rule out other conditions which may cause similar symptoms, such as:
- Genital warts
- Skin tags
- Seborrhoeic keratosis
- Lichen sclerosus
- Chronic herpetic lesions in those with underlying immunosuppression
- Blocked sebaceous glands
- Localised cysts
- Scarring, including keloid scarring
Sometimes patients may have lesions due to more than one cause and may receive more than one diagnosis simultaneously.
What is the long term prognosis for someone who has Molluscum contagiosum?
Most cases of Molluscum contagiosum clear spontaneously within 6–18 months and do not cause any ill effects. There is no association between Molluscum contagiosum and skin cancer and it does not predispose you to any other skin conditions.
Do I have to tell my partner I have (or had) Molluscum contagiosum?
It’s not necessary to tell your partners if you have or have had Molluscum contagiosum as it is very common, is passed on via simple skin-to-skin contact, and does not usually cause any harm. However if you have lesions present, it may be sensible to share this information with a partner, particularly if the lesions are on or near the genitals, as there is a high chance of spreading the virus to your partner. You may decide to use condoms to reduce the risk of sexual transmission until the lesions have completely resolved.
How can I prevent getting Molluscum contagiosum?
- Do not share personal items belonging to anyone with Molluscum contagiosum, including towels, clothes, bars of soap, sports gear or hairbrushes
- Avoid skin to skin contact with infected people
- Using a condom can help prevent the spread during sexual contact and intercourse
- Avoid sharing baths
- Practice effective hand washing
Managing stigma
Many patients are worried about how their diagnosis affects their future, in terms of relationships and social situations. Skin lesions can be perceived as a marker of poor hygiene and can carry significant stigma. It’s important to remember that the Molluscum contagiosum virus is very common and is easily passed from person to person, and infection does not reflect poor hygiene practices. It can be thought of as a common cold of the skin, and does not cause any ill effects or need any specific treatment.
How does Molluscum contagiosum virus affect pregnancy and childbirth?
MCV does not affect the pregnancy if the mother is infected with the virus, however it can be passed from mother to baby during childbirth if genital lesions are present.
Page reviewed by Dr. Manoj Malu (Clinical Director)
Last reviewed date: 6 June 2021
Next review due: 6 June 2024
Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.
References & Further Reading
- BMJ Best Practice (2019): Molluscum contagiosum
- British Association for Sexual Health and HIV (2014): Molluscum contagiosum
- British Association of Dermatologists (2018): Molluscum contagiosum
- British Association of Dermatologists (2021): Molluscum contagiosum in children
- NICE (2021): Clinical Knowledge Summary: Molluscum contagiosum
- Clin Cosmet Investig Dermatol (2019): Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment.
- NHS (2020): Molluscum contagiosum: Overview
- Terrence Higgins Trust (2018): Molluscum
- Centres for Disease Control and Prevention (CDC)(2015): Molluscum contagiosum
- Government of Western Australia: Department of Health. Molluscum contagiosum
- Healthdirect: Molluscum contagiosum
- Healthline (2018): Molluscum contagiosum
- The American Sexual Health Association: Molluscum contagiosum
- Patient.info (2020): Molluscum contagiosum
- Patient.info (2016): Professional resources: Molluscum contagiosum
- Medscape (2020): Molluscum contagiosum clinical presentation
- Practical Dermatology for Pediatrics: Separating Fact from Fiction in Molluscum contagiosum
- PLoS One: Seroprevalence of Molluscum contagiosum virus in German and UK populations
- J Clin Virol: Identification and genotyping of Molluscum contagiosum virus from genital swab samples by real-time PCR and Pyrosequencing
- Takeda UK (2020): Condyline: Patient Information Leaflet
- Phoenix Labs (2020): Warticon: Patient Information Leaflet
- Meda Pharmaceuticals (2016): Aldara: Patient Information Leaflet
- Galderma (U.K) Ltd (2018): Acnecide: Patient Information Leaflet
- HÄLSA Pharma (2017): MolluDab: Patient Information Leaflet
- Espère Healthcare Ltd (2020): Molutrex: Questions & Answers