Rare sexually transmitted fungal infection first seen in America

In early June, the first case of a rare sexually transmitted fungal skin infection was reported in New York. According to a report in JAMA Dermatology, the case involved a man in his 30s who developed an itchy rash on his genitals, limbs and buttocks after returning from a trip to England, Greece and California. The man reported having had multiple male sexual partners during his trip.

The organism responsible for the infection is known as Trichophyton mentagrophytes Type VII, a common fungus that can cause ringworm in humans and some animals, such as cats and dogs. This particular type of fungus can be transmitted sexually, especially when men have sex with men, but anyone can become infected, according to the CDC.

The infection was believed to have first been reported among sex workers in Southeast Asia, but between 2021 and 2022 it was also reported in 13 men in Europe, 12 of whom reportedly had sex with other men.

The New York City man who suffered from this sexually transmitted infection developed red, scaly patches on his genitals, buttocks, legs, arms and back. TMVII is a skin infection that causes rashes not only on the skin but also on the hair and nails.

Confirming a TMVII diagnosis can be particularly difficult because the rashes that occur can look very similar to other fungal infections or even an eczema outbreak. Doctors therefore need to be alert for this STI in the future and ask patients about travel, genital rashes, and sexual history, especially if rashes occur that have been resistant to standard treatments.

The only way to definitively diagnose TMVII is to obtain a fungal sample or scraping, which usually requires a skin biopsy.

Treatment can also be challenging, as was the case for the man in the US with TMVII. The man was treated with a standard antifungal called fluconazole for four weeks, with no improvement in his rashes. Most fungal skin infections are treated with topical antifungals or oral antifungals. In the American’s case, doctors eventually treated him with terbinafine and itraconazole, which relieved his symptoms.

Terbinafine is particularly effective in treating TMVII, according to reports in LiveScience. Although it may take months for the TMVII infection and associated rashes to completely clear up, antifungal medications like terbinafine work well against it.

Although this disease is rare and poses little risk to the general population, physicians must be on guard for this STI to avoid widespread transmission. TMVII poses significant challenges to healthcare professionals for several reasons. First, many healthcare professionals are not even aware of this infection, as only one case has been reported in the United States. This means that when skin lesions appear that look like TMVII, physicians may not ask about sexual history or travel history. In addition, because of the strong stigma surrounding STIs, patients may not volunteer their sexual history or may not want to admit they have genital rashes for fear or embarrassment of being judged. Finally, the diagnosis of TMVII cannot be made by observation or laboratory work alone, but requires sampling of the fungus from the skin.

Important tips for preventing fungal skin infections include washing hands frequently, keeping areas that may cause rashes clean and dry, avoiding sharing personal items, and wearing shoes to prevent fungal infections of the feet. Using protection during sexual intercourse should also be a top priority, especially in TMVII.