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How do I tell the difference between Mollusca and genital warts?

Dear Alice,

I read the info on molluscum in the Men's Health section. Are there any signs that distinguish molluscum from genital warts/any way to tell if you have one or the other?

Dear Reader, 

Molluscum can present as bothersome bumps, especially when it inhabits the genital region. To answer your question, yes, there is a way to tell molluscum contagiosum from genital warts. Mollusca—also known as water warts—is a condition of the skin caused by the molluscum contagiosum virus (MCV). Transmission of this virus can occur directly through skin-to-skin or sexual contact or indirectly through infected towels, toys, or other surfaces. While it’s primarily diagnosed in children ages two to five, it can still be spread to sexually active teens, adults, and those who are immunocompromised. Other risk factors include having eczema or asthma. 

Mollusca have some distinguishing characteristics that health care professionals use for diagnosis, including: 

  • Size: The bumps are typically small (approximately two to five millimeters across) and usually don’t grow or swell. However, scratching the lesion can cause it to spread to areas that weren’t previously affected. 
  • Color: Mollusca are usually firm, dome-shaped lesions that can appear white or flesh-colored. They may also be filled with clear or white fluid. 
  • Location: Mollusca may appear as a single bump or in groups, and are usually found on the face, neck, chest, and stomach. If the virus is sexually transmitted, lesions may be found on the genitals, inner thighs, and abdomen. 

These characteristics are different from genital warts in the following ways: 

  • Size: Genital warts are typically small and flat in size. However, if left untreated, it can grow larger and form masses that look like cauliflower. Additionally, genital warts can multiply into larger clusters if contracted by those who are immunocompromised. 
  • Color: Genital warts are rough textured and can appear as flesh-colored, brown, or pink. 
  • Location: Genital warts grow on or around the internal or external genitals (i.e., on or around the anus or penis and in or around the vagina). They can also be found in the throat and mouth if infected orally. 

Other ways that Mollusca and genital warts can be distinguished from each other include symptoms, complications, and prevention and treatment methods. Both Mollusca and genital warts are typically asymptomatic but can burn, itch, or bring discomfort in some cases. While both conditions usually resolve on their own, the virus that causes genital warts—the Human papillomavirus (HPV)— remains dormant and never truly leaves the body. On the other hand, once Mollusca has healed, the virus no longer exists in the body, although reinfection can still occur. Additionally, HPV can cause cancer (cervical, anal, oral, etc.), while Mollusca isn’t known to cause further medical complications or conditions. In terms of prevention, both conditions share some common measures, such as avoiding direct contact with lesions, not sharing towels, practicing safe sex, and sanitizing surfaces. However, there’s an additional preventive option for HPV, which is to receive the HPV vaccine. The HPV vaccine can provide protection against certain types of HPV and most HPV-related cancers. Finally, treatment for Mollusca and genital warts can include physical removal of the lesion or wart, topical medications such as podophyllotoxin, tretinoin, and possibly antibiotics. 

That being said, if you think you might have either of these conditions, it is helpful to talk with a health care provider for a diagnosis. They’ll be able to run the correct testing in order to more accurately distinguish Mollusca from genital warts. They can also discuss safer sex strategies and suggest appropriate treatment, if necessary.  Regardless of whether it’s Mollusca or genital warts, it’s great that you’re trying to scratch the itch of defining the difference between the two conditions. Hopefully, you’ll be on track to figure out any next steps. 

Best of luck, 

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Last updated Dec 22, 2023
Originally published Jul 18, 2002

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