The bottom view of a plate culture containing the fungus Trichophyton mentagrophytes. From the ... [+]
The first case of a rare fungal skin infection that is sexually transmitted was reported in New York in early June. According to a report from JAMA Dermatology, the case involved a man in his 30s that developed an itchy rash around his genitals, limbs and buttocks after returning from travel to England, Greece and California. The man reported having multiple male sexual partners while traveling.
The culprit organism responsible for the infection is known as Trichophyton mentagrophytes type VII, which is a common fungus that can cause ringworm in humans as well as some animals like cats and dogs. This specific type of fungus can be sexually transmitted, mostly when men have sex with men, but anyone can get it according to the CDC.
The infection was believed to have been reported first among sex workers in Southeast Asia, but was also reported among 13 men in Europe between 2021-2022, 12 of whom who reportedly had sex with other men.
The man in New York City with this particular sexually transmitted infection developed red, scaly patches around his genitalia, buttocks, legs, arms and back. TMVII is a skin infection that not only results in rashes on the skin, but also around hair and nails.
Confirming a diagnosis of TMVII can be particularly challenging because the rashes that develop can look very similar to other fungal infections or even an eczema flare. Thus, doctors must be aware of this STI going forward and should ask patients about travel, rashes around genitalia and sexual history particularly when encountering rashes that have been resistant to standard treatments.
The only way to definitively diagnose TMVII is through fungal sampling/scraping, which usually requires a skin biopsy.
Treatment can also pose a challenge, as was the case for the man in the United States with TMVII. The man was treated with a standard anti-fungal medicine known as fluconazole for four weeks without improvement in his rashes. Most fungal skin infections are treated with antifungal topical agents or oral antifungal medications. In the American man’s case, doctors finally treated him with terbinafine and itraconazole which improved his symptoms.
Terbinafine is especially effective at treating TMVII as per reports in LiveScience. Although TMVII infection and the rashes associated with it can take months to finally clear, antifungal medications like terbinafine work well against it.
Although rare with a low risk to the general public, doctors must be on the lookout for this STI to ensure there is not widespread transmission. TMVII poses significant challenges to the healthcare workforce 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 physicians may not ask about sexual history or travel when encountering skin lesions that look like TMVII. In addition, because there is so much stigma surrounding STIs, patients may not voluntarily share their sexual histories or want to disclose that they have rashes around genitalia for fear or shame of being judged. Finally, diagnosing TMVII cannot be done from simple observation or lab work alone, it requires sampling of the fungus from the skin.
Important tips for preventing fungal skin infections include washing hands often, keeping areas that may manifest as rashes clean and dry, avoid sharing personal items and keeping shoes on feet to prevent fungi from infecting the feet. In the case of TMVII specifically, using protection during sexual intercourse should also be a priority.