A sexually transmitted ringworm caused by a rare fungus has been reported for the first time in the United States.
The case report, published Wednesday in JAMA Dermatology by doctors at NYU Langone Health in New York City comes as doctors around the world increasingly say they are having trouble treating fungal infections.
“We think a lot about antibacterial resistance, but this is a really important time to be thinking about antifungal resistance,” said Mahmoud Ghannoum, professor of dermatology at Case Western Reserve University School of Medicine in Cleveland. He was not involved with the new report.
The new case involves a 30-year-old New York man who reported having sex with several men during a trip to England, Greece and California. When he got home, he developed a red, itchy rash on his legs, groin and buttocks.
Tests revealed that he had a sexually transmitted fungus called Trichophyton mentagrophytes type VII. This is the first time the fungus has been identified in the USA. Last year, Doctors in France reported 13 such cases. Twelve of these patients were men who have sex with men.
The American man’s infection responded to standard antifungal medications, but took four and a half months to completely heal.
He received fluconazole for four weeks without improvement, then six weeks of terbinafine and approximately eight additional weeks of itraconazole. All are oral antifungals.
He did not have any other infections that could make the problem worse.
Dr. Avrom Caplan, assistant professor of dermatology at NYU Grossman School of Medicine and author of the new report, said the case should raise awareness but not cause alarm among the general public.
“There’s no evidence that this is widespread or that it’s something people really need to worry about,” he said. “But if people are getting itchy rashes in areas like the groin and it doesn’t get better, see a doctor.”
The rash may look like eczema
Although the infection was likely transmitted through sexual contact, Caplan could not rule out the possibility that the man acquired the fungus in a sauna he visited two months before he developed symptoms. The man said his sexual partners showed no signs of ringworm.
Caplan said the rash may look more like an eczema flare-up than typical ringworm infections that form in circles. The infection is not fatal, but it can cause permanent scarring.
He previously identified the first two cases of a different ringworm infection in 2023. These infections, caused by Trichophyton indotineaeThey are not considered STIs, but they are drug-resistant and highly contagious.
Since then, Caplan’s team at NYU Langone Health has identified a total of 11 cases in Trichophyton indotineae ringworm in men and women in New York City.
The new case report is “remarkable,” said Jeremy Gold, a medical epidemiologist at the Centers for Disease Control and Prevention. He emphasized that doctors should consider fungi, along with viruses and bacteria, as a potential cause of sexually transmitted diseases.
“Often what happens is these patients are given multiple cycles of antibacterial medications that are not going to improve the fungus,” he said. “Doctors must keep this in mind so that patients can receive appropriate care.” He was not involved in the new case report.
Caplan also encouraged people to speak up and seek treatment. For now, Trichophyton mentagrophytes type VII it is treatable.
“If you have a rash or skin lesions that aren’t getting better and you think it might be ringworm,” he said, “see your doctor.”
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