Rare Sexually Transmitted Ringworm Reported in New York City

Introduction

A sexually transmitted ringworm caused by a rare fungus has been reported for the first time in the United States. The case report, published in JAMA Dermatology by doctors at NYU Langone Health in New York City, highlights a growing concern among clinicians worldwide about the difficulty in treating fungal infections.

The First U.S. Case: Details and Background

The case involves a New York City man in his 30s who reported having sex with multiple men during a trip to England, Greece, and California. Upon returning home, he developed a red, itchy rash on his penis, legs, groin, and buttocks. Tests revealed that he had a sexually transmitted fungus, Trichophyton mentagrophytes type VII (TMVII). This is the first time this fungus has been identified in the U.S. Last year, France reported 13 cases of TMVII, with most patients being men who have sex with men.

Diagnosis and Treatment Challenges

The American man's infection responded to standard antifungal medications but took four and a half months to heal fully. He initially received fluconazole for four weeks without improvement, followed by six weeks of terbinafine and approximately eight additional weeks of itraconazole. These are all oral antifungal medications. Dr. Avrom Caplan, an assistant professor of dermatology at the NYU Grossman School of Medicine and author of the report, emphasized that while the case should raise awareness, it should not cause alarm in the general public. "There’s no evidence that this is widespread, or that this is something that people really need to be worried about," he said.

Symptoms and Misdiagnosis

The infection caused by TMVII may appear more like eczema, with rashes that do not form the typical circles seen with other ringworm infections. This can lead to misdiagnosis and delayed treatment. The infection is not life-threatening but can cause permanent scarring if not treated promptly.

Rising Concerns About Antifungal Resistance

“We think a lot about antibacterial resistance, but this is a very important time for us to think about antifungal resistance,” said Mahmoud Ghannoum, a professor of dermatology at the Case Western Reserve University School of Medicine in Cleveland. Although he was not involved with the new report, his statement underscores the growing concern about antifungal resistance among health experts.

Global Context and Similar Infections

Caplan previously identified the first two cases of a different ringworm infection in 2023, caused by Trichophyton indotineae. These infections are not considered sexually transmitted infections (STIs) but are drug-resistant and highly contagious. Since then, Caplan's team at NYU Langone Health has identified a total of 11 cases of Trichophyton indotineae ringworm in both men and women in New York City.

Expert Opinions and Recommendations

Jeremy Gold, a medical epidemiologist at the Centers for Disease Control and Prevention (CDC), noted the importance of considering fungi as potential causes of sexually transmitted diseases. “Oftentimes, what happens is that these patients receive multiple courses of antibacterial drugs which are not going to make the fungus better,” he said. He stressed that doctors should consider fungi along with viruses and bacteria when diagnosing sexually transmitted diseases to ensure patients receive appropriate care.

Stigma and Public Awareness

Dr. Avrom Caplan also addressed the potential stigma associated with this infection. “Stigma and anxiety are possible, unfortunately,” especially given the recent focus on demographics impacted by mpox (previously known as monkeypox). However, he emphasized that TMVII is very different from mpox and there is no evidence it is widespread or endemic in the U.S.

Conclusion: Seeking Medical Advice

Caplan and other health experts encourage individuals to seek medical advice if they have any persistent rashes or lesions. “If you have a rash or lesions on your skin that aren’t getting better, and you think it might be ringworm, see your doctor,” Caplan advised. For now, TMVII is treatable with standard antifungal medications, but awareness and timely diagnosis are crucial for effective treatment.

Final Thoughts

This first U.S. case of sexually transmitted ringworm highlights the importance of awareness and proper medical diagnosis. As fungal infections become increasingly resistant to standard treatments, it is vital for both clinicians and the public to remain vigilant and informed.