U.S. authorities warn about an emerging sexually transmitted fungus
CATIE News
November 26, 2024
CATIE
- A new sexually transmitted infection has been reported in the U.S., chiefly among men
- This emerging fungal infection, called TMVII, can cause scaly lesions
- The infection may be difficult to diagnose but responds to antifungal drugs
In 2023, doctors in Paris, France, reported on an emerging fungal infection called TMVII (trichophyton mentagrophytes genotype VII). Now in 2024, researchers in the United States have identified the same fungus-causing infections in four men. Researchers in New York City and with the U.S. Centers for Disease Control and Prevention (CDC) have stated that this fungus can cause itchy, ring-like “scaly lesions on the trunk, groin, genitals, or face […].” They add that the fungus causes symptoms that “might be mistaken for eczema, psoriasis or other dermatologic conditions; and frequently requires oral antifungal therapy.”
Potential for complications
The researchers warn that “some patients can experience inflamed, painful and persistent lesions that can lead to scarring or [become infected with bacteria].” Therefore, it is important to have the lesions treated and to practice good hygiene, keeping the hands and affected skin clean.
Focus on fungus and people
The U.S. research team has presented brief details about four cases that were identified with TMVII in 2024. All patients had lesions sampled for analysis and definitive diagnoses were made by genetic testing for the fungus. Additionally, lab tests were done to find out if the fungus was susceptible to common antifungal drugs, and that was the case with terbinafine and itraconazole. All patients were treated for presumed TMVII infection before lab test results were available.
All patients were cisgender men who have sex with men, aged 30 to 39 years, who reported recent sexual contact with other men. Patients A and D had sex with each other; patients B and C did not have any contact with the other patients in this report. Patient B had travelled to Europe and patient D was a sex worker.
Patient A
This man had no underlying health conditions and was taking medicines to prevent HIV infection (HIV pre-exposure prophylaxis, or PrEP). He sought medical help for a rash on his buttocks. He was prescribed the antifungal drug clotrimazole, which he took for two weeks, followed by one week of applying terbinafine cream to his rash. However, these interventions did not resolve the rash. Doctors then prescribed oral terbinafine tablets (250 mg daily) for two to four weeks (he could stop if the rash resolved after two weeks). At his last clinic appointment, the rash was resolving.
Patient B
This man had HIV infection and what researchers described as “inconsistent adherence to [HIV treatment].” He sought care because of a rash on the corner of his mouth. He was prescribed clotrimazole cream, which he applied to the rash, and it cleared after one week of treatment.
Patient C
Researchers stated that this man had HIV that was “well controlled” due to treatment. He sought care because of a rash on his knee, buttocks and groin. Doctors prescribed oral terbinafine (250 mg daily) for four weeks. At his last clinic visit, the rash was clearing.
Patient D
This man was taking HIV PrEP and was also being treated with the drugs dabrafenib and trametinib for cancer. He sought care because of an itchy rash on his knee, trunk, arm and penile shaft. He was initially treated with oral terbinafine for less than a week, and then doctors changed his antifungal treatment to a combination of oral itraconazole (200 mg twice daily), luliconazole cream and ketoconazole cream. At his last appointment the rash was resolving.
A summary of the French data
In 2023, doctors at three hospitals in Paris reported 13 cases of TMVII. All cases were in men aged 22 to 59 years. The majority had sex with other men; one man had sex with both men and women. Seven of the men had HIV; in six of these men, the virus was under control. Five of the HIV-negative men were taking PrEP.
Most patients could take antifungal treatment at home. However, one patient developed a severe bacterial infection in the skin around his beard hairs and required hospitalization.
The antifungal drugs used differed among the patients but were most commonly oral formulations of one of the following: terbinafine, itraconazole or voriconazole. Treatment was prescribed for between three weeks and four months.
When the French doctors submitted their report, 10 of the patients had their fungal infection resolve, one was getting better, and no data were available on the remaining two patients.
The doctors noted that at least three patients developed darkened skin where the lesions had been. Two other patients developed scars or loss of beard hair (because their face was affected by fungal lesions).
Advice for healthcare providers
The U.S. research team advises healthcare providers that TMVII can spread through sexual contact and can cause lesions in the following areas:
- genitals
- buttocks
- face
- trunk
- arms/hands
- legs
They note that TMVII identification can take weeks. In the meantime, the researchers encourage healthcare providers to initiate treatment based on “epidemiologic and clinical features.”
The researchers further note that oral terbinafine (250 mg daily) is an effective first option for treating TMVII infection. They stated that some patients may require oral antifungal therapy for up to three months. The researchers do not recommend antifungal creams alone when the fungus has infected hair follicles. Furthermore, they caution against the use of corticosteroid creams, as these can weaken the immune system in the skin and allow the fungus to thrive.
Advice for patients
The U.S. researchers encourage patients to take all doses of prescribed medication “until the lesions have fully resolved.” They advise patients with TMVII to avoid the following:
- skin-to-skin contact with affected areas
- sharing personal items until the infection has resolved
—Sean R. Hosein
REFERENCES:
- Zucker J, Caplan AS, Gunaratne SH, et al. Notes from the Field: Trichophyton mentagrophytes Genotype VII - New York City, April-July 2024. Morbidity and Mortality Weekly Report. 2024 Oct 31;73(43):985-988.
- Jabet A, Dellière S, Seang S, et al. Sexually transmitted trichophyton mentagrophytes Genotype VII infection among men who have sex with men. Emerging Infectious Diseases. 2023 Jul;29(7):1411-1414.
From Canadian AIDS Treatment Information Exchange (CATIE).
This content was originally published by CATIE, Canada’s source for HIV and hepatitis C information.
Source: CATIE:
https://www.catie.ca/catie-news/us-authorities-warn-about-an-emerging-sexually-transmitted-fungus
For more information visit CATIE's Information Network at www.catie.ca
For more HIV and AIDS News visit...
Positively Positive - Living with HIV/AIDS:
HIV/AIDS News
|
