[Question #1424] Lesion/Molluscum Contagiosum

76 months ago
I am male and had unwanted receipt of Oral sex (less than 2mins) from a Chinese Male on 12th September 2016 where previous to the incident on the bottom of my penis had Molluscum Contagiosum lesions (7 nos) and my penis was bit nicked from regular masturbation although i am not sure his mouth made contact with the lesions or the nicked areas or not. 

I had a HIV p24 and antibody test (Elisa) on 17th October 2016 (5 weeks post exposure) and came back negative. Also was tested negative for chlamdiya and gonorhea 2 weeks post exposure.

Recently to my surprise i have another Molluscum Contagiosum lesion develop just above the bottom of the penis and although i saw the lesion grow from couple months ago now the lesion does not look the same as the other 7nos Molluscum Contagiosum lesions; initially i think it was due to the location of the new lesion as it perhaps regularly scratches on my pants making it scrub more than others and is more itchy and possibly looks different - another side of me has got me all worried and think perhaps its HIV or syphillis.???

So my questions as follows:

1) Do you think i was required to do the above testing ?
2) Is the test results above conclusive?
3) Is this new lesion possible still Molluscum Contagiosum however just looks different as i cannot differentiate between them?
4) I am using Aldara cream to remove the Molluscum Contagiosum - how long do you think this will take to remove all the lesions?

Thanks Doctor.

H. Hunter Handsfield, MD
76 months ago
Sorry to see you remain so anxious about the low risk event you experienced and that we discussed a month ago.

There is nothing about molluscum contagiosum, or about having a new MC lesion appear, that changes the reliability of your negative HIV test. And anyway, it sounds like this new lesion might not be MC at all, since it looks different. Or maybe it is MC whose appearance has been altered by self-treatment with Aldara. If it is an open sore, and especially if it is on a part of your penis that might have been exposed during the oral sex event, it could be syphilis. You should not make assumptions about it, but see a health professional ASAP to diagnose it. But whatever the cause, it does not change the fact that your massage parlor exposure was zero risk for HIV (or close to zero) and that you negative test proves you were not infected with HIV.

1,2) We discussed in your previous thread that this exposure did not require HIV tests. But you did it, the results were negative, and they are conclusive and prove you did not catch HIV. The gonorhrea and chlamydia results also are conclusive.

3) See above. I can't tell from your description what the cause of the new lesion might be. See a doctor, and perhaps have a syphilis blood test.

4) Stop using Aldara until you have see a doctor or clinic to diagnose it.

Regards--  HHH, MD

76 months ago
Hi Dr, thanks for the prompt reply.

Follow up questions as follows:

1) can i send you a photo of the lesion to assist me identify if its a MC lesion or syphillis as now im worried.

2) would a  syphillis test be conclusive after 10 weeks post exposure?

3) with you having a full history of my incident do you think my exposure was enough to get syphillis?

4) the new lesion is just above the bottom of the penis and i dont know if his mouth reach that far as i had told him to stop immediately after the brief exposure to his mouth. 

I saw the doctor few months ago and he told me the lesions were MC and prescribed aldara and hence i thought the latest lesion was MC as it looked the same initially but now looks slightly different especially when i put the aldara cream.  Im very confused doc and really tired from all of this :(
H. Hunter Handsfield, MD
76 months ago
1) Sorry, we don't examine posted photos. It comes too close to making a diagnosis and providing direct medical care, which we cannot do.

2) Yes, any time 6 weeks or more after exposure.

3) Syphilis is always a possible risk through oral sex, especially by men who have sex with men -- which of course describes your massger. But don't worry about how high risk the exposure was. If the test is negative, the exposure risk no longer matters.

4) This location makes syphilis unlikely. Syphilis lesions usually occur at the site of maximum friction during sex. Also, as I said above, if the lesion is not an open sore, then almost certainly it isn't syphilis.

I don't understand the reason for your "confusion". As I said above, Aldara can alter the appearance of MC lesions. If it looked like typical molluscum before you started treating it, that's probably what it is. But if you remain in doubt, seeing a doctor in person is the only way to know with certainty.
75 months ago
today i did a blood test for syphillis and came negative. The doctor locally said the lesion looks different because in his opinion it might be infected with bacteria and gave me some fusibact (fusidic acid) cream to treat it and he said for the MC he can freeze them for me- didnt know if this was good way?

1) can i conclude that i am hiv and syphillis free from the dates i took the tests even though i suffer from high tsh levels and can i conclude this sore / lesion/infected lesion or whatever it is definitely is not a hiv / syphillis sore?

2) shall i use the fusibact cream and you think this the way to go? Or shall i do the freezing method as opposed to aldara which way is quicker

3) do you think i need to be retested  in future or shall i put this to bed now?

Thanks doc for your help and you have been great help to me and i wish one day to see you in DC to thank you personally and commend you for the work you are doing.

H. Hunter Handsfield, MD
75 months ago
Your doctor probably knows as much about treating MC as I do. Follow his advice. Cryotherapy (freezing) is often the best treatment -- it's effective all at once, without requiring ongoing application like Aldara does.

1) Already answered, see aboe. I see no reason to repeat myself.

2) Freezing. The antibiotic will help only if there is an additional superficial bacterial infection, but will not treat any remaining MC in that spot.

3) Also answered above. You don't need any more STD testing.

That concludes the two follow-up comments/replies with each thread, and so concludes this discussion. Follow your doctor's advice, and do your best to move on without fear or concern about STDs.