This week, GU specialist Dr Derek Freedman continues talking about the various cosmetic maladies that can afflict 'down there'.

What are Molluscum Contagiosum?

They are small pearly cysts on the skin with a small spot in the centre, which spread quite rapidly. They are caused by a Pox virus and have little consequence, except they look unsightly. They appear anything from 3 to twelve weeks after skin-to-skin contact. They are usually cleared by the immune system, although we treat them to speed up their clearance, and for cosmetic reasons.

How are they treated?

A freeze with liquid nitrogen is best. But you usually need several courses of treatment.

Some people have little cysts, or little tags on their genitals -- are they OK?

They are the sebaceous cysts that are a normal part of the skin but on the thinner skin of the genitals they look more prominent. The same can be said for the little skin tags or the frond-like areas of the skin. They are more prominent on some people and give them a fright, especially after a risky night. It is hard for people to know what is normal and what is a sign of something wrong -- after all, we do not go around comparing our genitalia.

How can you tell the difference between cysts and warts?

These cysts and skin tags are an integral part of the skin. When you feel them they are soft and smooth. The individual tags do not grow together to form a lump.

Warts are harder, thicker and denser than normal skin and on magnification are seen to coalesce together as a lump. With special acid staining, they turn white and are easily identified by an experienced doctor.

Do normal skin diseases affect the genitals?

Of course. One often sees the first signs of psoriasis in a young person as a lesion on the genitals. The lesion may not be the typical plaque in the warm moist environment of the genitals.

There are some skin conditions that mainly present on the genitals but also in the mouth. These require specialist assessment and a biopsy for diagnosis.

Do some sexually transmitted infections present as skin conditions?

Of course. That is why the specialties of Venereology and Dermatology are joint in many parts of the world. Syphilis classically presents first as a skin lesion or a chancre and then as a generalized rash.

Today, HIV is associated with a particular type of rash initially and skin conditions later on -- just like syphilis and glandular fever. Even chlamydia and gonorrhoea can cause rashes. And of course, there is always the rash of anxiety!

If you're worried you might have an STI, contact St James's Hospital GUIDE clinic at 01 416 2315/416 2316. Treatment is free of charge

- Dr Derek Freedman