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You may have seen recent reports about an increase in cases of Trichophyton mentagrophytes genotype VII (TMVII), a strain of ringworm that spreads through close skin-to-skin contact and has been reported primarily among men who have sex with men. Our clinicians are familiar with this condition and are prepared to help with diagnosis and treatment if needed.

So what exactly is TMVII, and what should you know about it? Let’s break it down.

What are Trichophyton Mentagrophytes (TMVII)?

The infection, called Trichophyton mentagrophytes type VII (TMVII), typically causes a severe rash on the genitals, buttocks, arms, legs, or abdomen. The infection presents very similarly to ringworm. The redness may be mistaken for eczema or other skin conditions, leading to delays in diagnosis and treatment. It can cause inflamed, painful, itchy, and persistent skin lesions, located on the genitals, buttocks, or face. The infection appears as “round, coin-like rashes that are red and irritated, sometimes with bumps and pimples on top,” according to the Minnesota Department of Health, and it can lead to scarring and secondary infections.

How is TMVII spread?

TMVII is an emerging dermatophyte fungus that can be spread during sex, direct skin to skin contact, and through clothing, towels, and bedding that have not been disinfected after use by someone with TMVII. TMVII has been circulating in Europe for several years, mostly reported among men who have sex with men. Some cases have also occurred among people who traveled to Southeast Asia for sex tourism.

TMVII infections were first recognized in the United States in the summer of 2024. Since then, cases have been identified in multiple U.S. cities including over 30 cases just in Minnesota. TMVII is not currently considered widespread nationally.

What are the symptoms of TMVII?

Lesions typically involve the genital, perineal/vulva/scrotum, and perianal/butthole areas but may also occur on the face or other shaved/waxed sites with skin barrier compromise. Typical lesions of tinea corporis may also be seen. Lesions may mimic eczema or psoriasis. Deep follicular or nodular involvement can occur and may contribute to prolonged treatment needs. Lesions may be markedly inflammatory (nodules, kerion-like plaques, Majocchi-type involvement) and may mimic Mpox, Herpes, or bacterial infections.

“Because it can mimic eczema or other infections, it could be misdiagnosed. If you think you may have symptoms or were exposed, it’s important to speak with your health care provider so you can be evaluated and treated.” says Dr. Questel, Medical Director of the Columbus, Ohio Central Outreach Wellness Clinic.

If you believe you may have been exposed to TMVII, the CDC recommends avoiding skin-to-skin contact with affected areas and refraining from sharing personal items until symptoms have fully resolved.

What is the treatment for TMVII?

If a ringworm-like rash shows up on your body, speak to a doctor immediately. If you think you might have TMVII please consult your doctor or health provider right away. Testing for TMVII includes collecting skin scrapings for fungal culture and submitting isolates to the state public health laboratory. If you believe your clothes have come into contact with the fungal infection or spores, wash your clothing on high heat or simply throw them away.

If TMVII infection is suspected the recommended treatment is to orally take terbinafine 250 mg daily. Patients are required 6–12 weeks of therapy, with some requiring longer for deep or highly inflammatory lesions. In cases with inadequate response after several weeks of terbinafine, itraconazole has been successfully used as second-line therapy despite no confirmed terbinafine resistance in TMVII to date. Topical antifungal agents may be helpful as a secondary treatment but are not recommended as the treatment for TMVII given limited evidence of efficacy. Clinicians are encouraged to monitor patients throughout treatment for disease resolution. Some experts recommend extending therapy 2–4 weeks beyond clinical resolution to reduce relapse risk, although evidence is limited. Hospitalization may be required.

Central Outreach is here for you!

If you think you have TMVII please immediately come see a doctor or nurse at Central Outreach. Stop the spread of the infection by being in charge of your sexual health. We are always here to help and we provide multiple services including STI testing, treatment, and gender affirming care. 

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