Can Adults Get Molluscum Contagiosum?
Yes, adults absolutely can develop molluscum contagiosum, and in adults it is primarily transmitted through sexual contact, making it a sexually transmitted infection (STI) that requires screening for other STDs. 1, 2, 3
Epidemiology and Transmission in Adults
- Molluscum contagiosum affects three main populations: children, sexually active adults, and immunocompromised individuals. 1, 2
- In adults, transmission occurs predominantly through sexual contact, with lesions characteristically appearing in the genital and perigenital regions. 3, 4
- Adult males appear to be affected more frequently than females, with male-to-female ratios ranging from 3.3:1 in some studies. 5
- Direct intimate skin-to-skin contact is sufficient for viral transmission—penetrative intercourse is not required. 2
Clinical Presentation Differences Between Adults and Children
- In immunocompetent adults, lesions typically remain confined to the genital area and adjacent skin regions, whereas children and immunocompromised patients develop lesions on various body sites. 2
- Adults with perigenital molluscum have high rates of concurrent STIs: 30.4% of men and 32.1% of women in one study had one or more co-existent sexually transmitted diseases. 6
- Even when molluscum is the only presenting symptom, concurrent STIs are found in 23.2% of men and 10.5% of women, indicating the need for comprehensive screening. 6
Special Considerations for Immunocompromised Adults
- Adults with HIV/AIDS or other immunosuppressive conditions develop more severe, extensive, and recalcitrant molluscum lesions that may appear extragenitally. 3, 4
- The presence of multiple large lesions with minimal inflammation should prompt evaluation for underlying immunocompromise, particularly HIV infection. 7, 8
- HIV-positive adults may present with atypical manifestations including giant molluscum or furuncle-like lesions. 5
- Molluscum onset in HIV-positive individuals can be part of immune reconstitution inflammatory syndrome (IRIS). 3
Management Approach for Adults
- All adults with perigenital molluscum contagiosum should be screened for other sexually transmitted infections and their sexual partners should be contact-traced, typically requiring referral to a sexual health clinic. 6, 4
- Active treatment is recommended for adults to prevent transmission to sexual partners, shorten infection duration, and address cosmetic concerns. 7, 9
- Physical removal methods (curettage, excision with cautery, or cryotherapy) are first-line options, with curettage being particularly effective as it reduces viral load and enables immune clearance. 7, 8
- For immunocompromised adults with severe or recalcitrant disease, systemic agents such as cidofovir or interferon may be necessary. 7, 4
Common Pitfalls in Adult Cases
- Do not assume molluscum is only a pediatric condition—missing the diagnosis in adults delays appropriate STI screening and partner notification. 3, 6
- Extragenital lesions in adults should raise suspicion for immunosuppression and warrant HIV testing. 3
- Avoid the "watch and wait" approach in adults, as this increases transmission risk to sexual partners and prolongs psychosocial burden. 9
- Do not use imiquimod expecting therapeutic benefit, as randomized trials show no advantage over placebo. 7, 8, 4