New sexually transmitted fungal infection detected in NYC — the first case in the US

Health experts are warning of new and highly contagious fungal strains after an NYC man in his 30s developed a sexually transmitted form of ringworm — the first reported case in the US.

“Healthcare providers should be aware that Trichophyton mentagrophytes type VII [TMVII] is the latest in a group of severe skin infections to have now reached the United States,” said Dr. Avrom S. Caplan, an assistant professor in NYU Grossman School of Medicine’s dermatology department.

Caplan co-authored a case study published Wednesday about an unidentified New Yorker who became infected with TMVII, with a rash appearing on his penis, buttocks and limbs. Cases of TMVII have been on the rise in Europe, especially in 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 disclosed similar skin issues.

“Since patients are often reluctant to discuss genital problems, physicians need to directly ask about rashes around the groin and buttocks, especially for those who are sexually active, have recently traveled abroad, and report itchy areas elsewhere on the body,” study senior author Dr. John G. Zampella advised.

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

A different itchy and contagious skin infection that causes rashes similar to TMVII is proving to be a greater challenge for dermatologists.

Trichophyton indotineae — which is widespread in India and was first confirmed in the US last year — often resists terbinafine treatment, the NYU Grossman School of Medicine researchers said.

They analyzed data from 11 men and women treated for Trichophyton indotineae in NYC hospitals between May 2022 and May 2023.

Seven of the patients received standard doses of terbinafine. Their rashes did not clear up, perhaps because of genetic mutations in the fungus.

The antifungal pill itraconazole yielded better results, but Caplan cautioned that the drug can interfere with other medications and cause nausea and diarrhea, among other side effects.

Caplan said that while dermatologists should be on the lookout for TMVII and Trichophyton indotineae, US rates so far remain low. His team hopes to expand their research into the two species of fungus over the next few months.

“These [initial] findings offer new insight into how some of the fungal skin infections spreading from South Asia can evade our go-to therapies,” Caplan said. “Beyond learning to recognize their misleading signs, physicians will need to ensure their treatment addresses each patient’s quality of life needs.”