HPV vs Herpes vs Molluscum: Telling Bumps Apart

Three different infections can cause bumps in the same places, and it is easy to mix them up. This page describes the usual patterns so you know what to mention to a clinician. Looks can overlap, so none of this replaces an exam.

What is the difference between herpes and HPV?

They are two different viruses. The CDC states that HPV is a different virus from HIV and from HSV (herpes). In practice:

• HPV can cause genital warts, but most HPV infections cause no symptoms.
• Herpes (HSV) causes outbreaks of blisters and sores that come and go.

Neither one is a sign that you did anything wrong, and both are common.

What do genital warts from HPV look like?

Genital warts are usually a small bump or a group of bumps. They can be raised or flat, soft or firm, and may be shaped like a cauliflower. They can be skin-coloured, white, red or darker than the skin around them.

They usually cause no symptoms, though some are itchy, painful or bleed.

What does herpes look like compared with warts?

Herpes often comes with tingling, burning or pain. The NHS describes small blisters that burst to leave red, open sores around the genitals, anus, thighs or bottom. On brown or Black skin the sores may be less red. People often feel tingling, burning or itching first, and may have pain when they pee.

The sores clear up by themselves but can come back in the same area. A clinician confirms herpes by swabbing a sore, which can’t be done once it has healed.

What does molluscum look like?

Molluscum bumps are about 2 to 5 mm wide, raised and dome-shaped, often with a shiny white dimple in the middle, and they usually appear together. The CDC says they are usually white, pink or skin-coloured and feel firm, from the size of a pinhead to a pencil eraser. They may be itchy, sore or swollen.

In adults, molluscum caught through sex often appears around the lower tummy, genitals and thighs. It usually clears without treatment, within about six months to a year, though it can take longer. Don’t squeeze or scratch the spots, because that can spread them or cause an infection.

What harmless things can look like warts?

• Pearly penile papules. These are small, dome-shaped to thread-like, skin-coloured bumps arranged in one or more rows around the head of the penis. DermNet says they are a normal anatomic variant, not due to sexual activity or hygiene, and not contagious.
• Fordyce spots. These are small yellowish or white raised dots on the lips, inside the cheeks, or on the genitals. DermNet says they are not an STI and not infectious.

Some other genital growths need medical care. The CDC notes that some lesions resemble warts but do not respond to wart treatment, and that condyloma lata, a manifestation of secondary syphilis, can be diagnosed with blood tests.

How do clinicians tell them apart?

For genital warts, a clinician usually looks at them. The CDC says HPV testing isn’t recommended, since the results don’t confirm warts or guide treatment. A small sample may be taken if a lesion looks unusual.

For herpes, a swab of the sore is the most sensitive test, as covered above. For molluscum, the NHS recommends seeing a doctor if you’re not sure the spots are molluscum, if they’re near your genitals, or if you have a weakened immune system. The CDC says molluscum sores around the genitals usually warrant treatment, so see a provider as soon as you can.

What should I do in the meantime?

• Don’t squeeze, pick or try to remove the bumps.
• Don’t use pharmacy wart treatments on genital skin.
• Avoid sexual contact until a clinician has looked at them.
• Photograph the area each day, which can help if the bumps change.
• Wash your hands after touching the area, and don’t share towels or clothing, since molluscum can spread on shared items.