New sexually transmitted fungal infection discovered in NYC

Health experts are warning of new and highly contagious strains of the fungus after a man in his 30s in New York City contracted a sexually transmitted form of ringworm – the first reported case in the United States.

“Healthcare providers should be aware that Trichophyton mentagrophytes type VII (TMVII) is the latest in a group of serious skin infections that have now reached the United States,” said Avrom S. Caplan, MD, assistant professor in the Department of Dermatology at NYU Grossman School of Medicine.

Caplan is co-author of a case study published Wednesday about an unidentified New York man who contracted TMVII and developed a rash on his penis, buttocks and limbs. In Europe, cases of TMVII are increasing, especially among men who have sex with men.

The man in the new case study had visited England, Greece and California. He reported having sex with men during his travels, none of whom had similar skin problems.

“Because patients are often hesitant to discuss genital problems, physicians need to ask directly about rashes in the groin and buttocks, especially in sexually active patients who have recently traveled abroad and report itchy spots elsewhere on the body,” advises lead study author Dr. John G. Zampella.

Zampella noted that infections caused by TMVII seem to respond to standard antifungals, such as the drug terbinafine (also known as Lamisil), but they can take months to clear up. They can also be confused with lesions caused by eczema, which can delay treatment.

Another itchy and contagious skin infection that causes rashes similar to TMVII poses a greater challenge for dermatologists.

Trichophyton indotineae – which is widespread in India and was first confirmed in the United States last year – often resists treatment with terbinafine, said researchers at NYU Grossman School of Medicine.

They analyzed data from 11 men and women who were treated for Trichophyton indotineae in New York hospitals between May 2022 and May 2023.

Seven of the patients received standard doses of terbinafine. Their rashes did not improve, possibly due to genetic mutations in the fungus.

The antifungal drug itraconazole showed better results, but Caplan warned that the drug could interfere with the effects of other medications and cause nausea and diarrhea, among other things.

Caplan said dermatologists should be on the lookout for TMVII and Trichophyton indotineae, but numbers in the U.S. are low so far. His team hopes to expand research on those two fungal species in the coming months.

“These (initial) findings provide new insight into how some of the fungal skin infections originating from South Asia can evade our standard therapies,” Caplan said. “Physicians must not only learn to recognize their misleading signs, but also ensure that their treatment meets the quality of life needs of each patient.”