Is Molluscum Contagiosum a type of HIV?

Molluscum Contagiosum- started off as a strange growth on the private area, looks like acne, but it doesn't go away, it seems to grow more in numbers, and spreading towards other parts of the body. Acne cream does not resolve it. 

Molluscum Contagiosum can be a STD. 

Does it signify the presence of HIV?

We are here to explore the association between Molluscum Contagiosum and HIV/STD. 

What is Molluscum Contagiosum?

Molluscum contagiosum (MC) is an infectious, inflammatory skin condition that affects the young, sexually active person and those with weaker immune system regardless of the age. It is a virus skin infection due to poxvirus. It is more commonly found in places with warm temperature, overcrowded environment. Impaired skin integrity, underlying inflammatory skin conditions, chronic long immune system can predispose one to contracting molluscum contagiosum.

In those with good general immune system, one may notice the lesion may resolve spontaneously. Having said that, the layback, non-interventional, watch-and-wait approach can result in spreading of diseases to self and others, resulting in more extensive disease, persistent infection, physical discomfort and negative psychosocial impact. 

How is Molluscum Contagiosum transmitted?

Molluscum contagiosum can be transmitted through

• Skin-to-skin contact, hence this includes sexually transmission in adults 
• Formic-to-skin contact (bedding, sauna and onsen, towel to skin of affected person)
• Self-auto-inoculation from 1 area of the body to another via shaving, picking or scratching

Moist medium such as body fluid, swimming pool, sauna facilitate the transmission of the virus.

Those with impaired skin barrier (such as in those with atopic dermatitis), open wound, poorer immune system can contract the virus easier.

How does Molluscum Contagiosum look like?

Molluscum contagiosum tends to present with discrete small pimple-like (papules), slightly glossy with a center depression (known as umbilication). The lesions tend to appear in groups (crops) and can be whitish or pinkish in color. Inside the pimple-like lesion, there is a white cheesy core. It can affect any part of the skin surfaces, though it is more frequently seen in the moist areas such as the genital area, armpit, but occasionally can be seen on the hands, face and neck.

Due to the persistence of the viral infection, one may notice the surrounding skin of the molluscum lesion tends to be inflamed, red-pink and itchy. In some, due to scratching, the lesion can turn crusted and scabbed.

Association of Molluscum Contagiosum with HIV infection

In Human Immunodeficiency Virus (HIV), due to constant, progressive attack and weakening of the immune system, one can become more susceptible to contracting various infections- be it fungal, bacterial or viral infections. In a healthy immune system, our body is able to mount an immune response with the white cells to eradicate and fight-off the infections. In HIV, due to low and dwindling counts of white cells, the body is not able to ward-off infections effectively.

In the case of Molluscum Contagiosum, with a compromised immune state from HIV infection, one can have  

• Recurring symptoms of molluscum lesions
• Atypical (unusual) hypertrophic (large/ giant) molluscum that can look like skin cysts
• Disseminated and numerous (can be hundreds!) molluscum lesions

The distribution of Molluscum Contagiosum in HIV can occur anywhere of our body surface but with a predilection over the genitals, head, eyelid and neck.

How important is it for HIV and STDs screening when there is Molluscum Contagiosum?

While Molluscum Contagiosum can possibly be acquired via non-sexual route, when these lesions are seen over the genital or pelvic area, it is invariably acquired through skin-to-skin sexual activities.

The presence of genital Molluscum Contagiosum though is a skin infection, may signify a deeper medical concern- such as

• Poor immune system secondary to other medical conditions such as diabetes, autoimmune conditions, HIV etc
• Concurrent STD exposure and infection

Let's not also forget that when one has an unresolved STD, one is at higher risk of contracting subsequent 2^nd , 3^rd , 4th, etc of STDs.

Early screening, early detection and early treatment are key in nipping STD infections in the bud. Managing concurrent medical conditions, STDs will aid the recovery of Molluscum skin infection.

Above are reasons why STD screening should be offered in the event of Molluscum Contagiosum and if there is risk of exposures to sexually transmitted infections.

What happens if I leave Molluscum Contagiosum and decide not to treat them?

It is possible that Molluscum Contagiosum can eventually resolve spontaneously over a course of 6-18 months. (This occurs in 70% of patients with average immune system.) Unfortunately, some patients may have persistent symptoms up till even 5 years.

During the period when Molluscum Contagiosum lesions are present, one runs a risk of

• Disfigurement due to chronic inflammation of the molluscum lesions, resulting in permanent scarring
• Spreading of infection to other parts of body, affecting spouse/ sexual partner(s), less commonly even to newborn (from affected pregnant mother)
• Developing secondary bacterial infection over the Molluscum skin lesions
• Worsening underlying skin conditions such as eczema
• Acquisition other STDs

How can I treat Molluscum Contagiosum?

Medical treatment for Molluscum Contagiosum can be offered safely in clinic settings. As the eradication of the viral infection is dependent to one's immune system, mollusca lesions may continue to surface during treatment if underlying immune system is not addressed or improved on, and repeated treatment may be required to clear off the infection.

It is worth discussing with your doctor on which option of treatment is more suitable in your case.

Take home message...

HIV is a virus that attacks and weakens a person's immune system. Those who have HIV not only are susceptible to a myriad of infections, they are predisposed to persistent infection and inflammation such as in the case of Molluscum Contagiosum. While both conditions are caused by different viruses, in the context of sexually active individuals, persistent Molluscum Contagiosum may be suggestive of underlying immunocompromising state such as HIV infection. For that reason, HIV or co-existing STDs should be screened to avoid further delay of treatment and overall better outcome for both Molluscum Contagiosum and HIV (if present).

Contact Dr Ben Medical

Understanding your skin and sexual health can feel overwhelming, but you don’t have to navigate it alone. When you’re ready, our clinic is available to answer any questions you may have. Feel free to contact us!

References:

1. Alghamdi A, Alghamdi YS, Hanafi H, Karami MM, Khayyat W, Hersi RM, Naaman NK. A Giant Eyelid Molluscum Contagiosum Revealing an HIV Infection: A Case Report and Literature Review. Cureus. 2023 Jun 30;15(6):e41187.
2. Hardiani, N. L. R. M., Suryana, K., & Suhardinatha, K. A. Molluscum contagiosum could become an early sign of HIV infection. International Journal of Advances in Medicine. 2022; 9(12), 1207–1210.
3. Kaufman WS, Ahn CS, Huang WW. Molluscum contagiosum in immunocompromised patients: AIDS presenting as molluscum contagiosum in a patient with psoriasis on biologic therapy. Cutis. 2018 Feb;101(2):136-140.
4. Guidelines on the Treatment of Skin and Oral HIV-Associated Conditions in Children and Adults. Geneva: World Health Organization; 2014. 11, Evidence and recommendations on molluscum contagiosum. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305396/
5. Filo-Rogulska M, Pindycka-Piaszczyńska M, Januszewski K, Jarząb J. Disseminated atypical molluscum contagiosum as a presenting symptom of HIV infection. Postepy Dermatol Alergol. 2013 Feb;30(1):56-8.