A news release from academic medical centre NYU Langone on 5 June 2024 describes a very rare confirmed case of a sexually transmitted fungal rash in the US. A man in his thirties experienced tinea (a fungal rash also known as ringworm) on his groin, buttocks and limbs and was diagnosed with the fungus Trichophyton mentagrophytes type VII (TMVII). He reported recent travel to Europe and multiple male sexual partners during that time.
This is not the first case of sexually transmitted TMVII. 13 cases of TMVII were diagnosed in France in 2023 among men who have sex with men (MSM), and the man’s recent travel to Europe may account for his case. In 2023 the US reported its first case of Trichophyton indotineae, a similar fungal species resistant to antifungal treatments. T indotineae is highly prevalent in India and can now be found globally. It presents similarly to TMVII and can also be transmitted sexually.
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Trichophyton, Microsporum, and Epidermophyton fungi all cause ringworm. Ringworm presents as an itchy ring-shaped rash on the face or limbs and includes subtypes jock itch (groin), athlete’s foot (feet), and onychomycosis (nails). Tinea can be diagnosed by a general practitioner or dermatologist. Tinea is spread via skin-to-skin contact and via shared objects and surfaces. It can be prevented by hygienic practices such as keeping skin clean and dry, and changing underclothes daily. As with other sexually transmitted infections (STIs), transmission can be prevented via condom use, communication with your partner about their sexual health status and abstinence while affected.
A study on the above TMVII case notes that two factors may impair diagnosis of sexually transmitted tinea cases: stigma and identification. According to study author Zampanella, patients may not have genital tinea diagnosed because of a hesitance to discuss genital issues. This puts the onus on healthcare providers to ask about potential infections. This may have been compounded in the June 5 case because of the sensitive nature of STIs found in MSM communities.
Genital tinea cases have been described as visually closer to eczema, rather than the characteristic ring shape of ringworm. This can delay correct diagnosis and treatment — especially since steroid treatments exacerbate fungal infections.
GlobalData epidemiologists predict 73,499 incident cases of invasive fungal infection and 11,443,659 diagnosed prevalent cases of onychomycosis in 2024. Sexual transmission of fungus may cause an uptick in cases as diagnosis increases. Adding fungal testing to STI panels and increasing training on fungal pathogens in OBGYN [obstetrics and gynaecology] and other reproductive healthcare settings may help address this issue before it becomes widespread.
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