Q: I was sexually active & was cured of molluscum in the genital area. The number was 15 to 20. I am 39 years old. I got tested for CBC a month back and found that the WBC is 6000; Neutrophils 54%, Lymphocytes 35%, Monocytes 6%, Eosinophils 5%; RBC 5.6, Haemoglobin 16.5 and platelets adequate. Does molluscum show extensiveness in HIV+ people at any CD4 count or only at CD4 <200? Is the low WBC due to molluscum or any other reason? Does molluscum virus cause other infections like penile yeast to recur? Is my blood picture OK?

A:Molluscum contagiosum is a mild viral disease of the skin caused by a poxvirus, which infects the upper skin layer (epidermis). Close physical contact, fomites, and autoinoculation (patient manually spreads the infection from one part to another by touching or scratching) are the main routes of transmission. Crowded living conditions, use of public swimming pools, and sharing of clothes/towels by infected persons too help spread of the virus. Most occurrences in adolescents and adults are secondary to sexual contact. Cell-mediated immunity is important as children and HIV-infected patients tend to have more widespread and persistent infection. Immunocompromised individuals (e.g. patients on prednisolone or methotrexate) have a more generalised and prolonged illness that may be resistant to treatment. The incidence and severity of the infection in HIV-positive individuals is inversely related to the CD4 count. As the virus does not induce a strong antibody response, reinfection is common. Healthy (immunocompetent) patients are treated with chemical or physical agents like cantharidin and cryotherapy while more aggressive therapy with antiviral drugs is required in patients who are immunocompromised. Superinfection or secondary infection is likely in immunocompromised individuals who need to be treated with antibiotics. Your complete blood counts (both total leukocyte count of 6000/ml and differential count) are normal.