Ringworm can now be sexually transmitted
Key Takeaways
The first case of a sexually transmitted form of tinea has been reported in the US.
Tinea genitalis/pubogenitalis from Trichophyton mentagrophytes type VII (TMVII) is a sexually transmitted form of ringworm.
This form of tinea may appear different from typical neat ringworm circles and be confused for eczema lesions.
A highly contagious form of tinea spread via sexual contact has been reported in the US for the first time.[]
Tinea genitalis/pubogenitalis from Trichophyton mentagrophytes type VII (TMVII) is a sexually transmitted form of ringworm that has been increasing in prevalence across Europe, primarily in men who have sex with men.
“What the recent literature tells us from Europe is that for some patients it can cause inflammatory lesions that can look like an abscess, become superinfected with bacteria, and can lead to scarring. This doesn't happen for all patients, but that can happen. [It’s] also problematic because of how it seems to spread between people, which appears to be sexual contact. That can lead to anxiety and concerns about stigma, especially given reports of TMVII among men who have sex with men,”Avrom S. Caplan, MD, an assistant professor in the Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, tells MDLinx.
Dr. Caplan is the lead author of research published in JAMA Dermatology that details the first reported US case of tinea genitalis/pubogenitalis from TMVII.[]
A male in his 30s developed tinea on his limbs, buttocks, and penis after returning to New York City from a trip to England, Greece, and California.[]
Genetic tests of fungal samples collected from the patient identified TMVII.
The patient reported having multiple male sexual partners during his travels, though none have reported having similar skin issues.
Dr. Caplan argues that clinicians should consider tinea of this type if patients present with rashes in their genital area.
“We don't typically think of tinea as occurring in the genital and pubic region, so one reason we reported this is to increase awareness among clinicians. Also, some patients may first go to primary care, emergency rooms, sexual health clinics—not just dermatologists. So, in general, it's important to keep tinea in mind for these types of itchy rashes. We also reported on this because TMVII in the literature has been reported among men who have sex with men, and in returning travelers from Southeast Asia who had contact with local sex workers. So, if we're seeing patients with rashes in the groin, and especially in the context of potential transmission during sex, then we should also keep tinea in mind,” he says.
Tinea from TMVII may appear different from the typical neat circles often seen in ringworm and may be confused for eczema lesions. As a result, it can go without proper treatment for months.
Adam Friedman, MD, FAAD, Professor and Chair of Dermatology at The George Washington University School of Medicine and Health Sciences, says that physicians should undertake KOH prep tests.
“Fewer and fewer individuals are doing appropriate bedside testing—called a KOH scrape prep—to identify the fungal elements at the bedside vs basing the diagnosis only on clinical inspection. The golden rule is ‘if it scales, scrape it,’” Dr. Friedman tells MDLinx.
“Embrace the joy of performing KOH preps in your office! [They’re] easy, inexpensive, and can really change the treatment course with the correct diagnosis,” he adds.
TMVII appears to respond to standard oral antifungal medications. In some cases, patients may be switched to next-line medications.[]
Dr. Caplan notes that while TMVII does not appear to be endemic in the US, physicians should be aware that patients may be reluctant to discuss rashes in the genital area. Physicians will therefore need to begin a discussion about it.
“In many of the TMVII reports, patients often have tinea rashes elsewhere on the body, so as a starting point, if seeing rashes that may be consistent with tinea, it's important to ask patients where else on the body they may be having issues. And we can say things such as, ’some people who have these types of rashes on their bodies also get them in the genital or buttock region, and that's important for us to know because it can impact our treatment choices. Do you have any concerns about rashes in these areas?’" Dr. Caplan tells MDLinx.
“As far as we know, TMVII is not endemic here, but another reason we reported it is so that clinicians and public health authorities can look for it going forward. If someone has an itchy, scaly rash in the genital region, they should get treated before having sex with others,” Dr. Caplan adds.
What this means for you
The first case of a sexually transmitted form of tinea has been reported in the US. Tinea genitalis/pubogenitalis from Trichophyton mentagrophytes type VII (TMVII) is a sexually transmitted form of ringworm that has been increasing in prevalence across Europe. TMVII may appear different from typical neat ringworm circles be confused for eczema lesions; it responds to standard oral antifungal medications.