An unwelcome germ visitor to the Big Apple is making itself cozy. In a recent paper published last month, scientists have reported the growing emergence of a sexually transmitted ringworm fungus—one that has infected at least five people in New York City this year.
There are over 40 different types of fungi known to cause ringworm, which is a broad term for fungal infections of the skin, hair and nails (the name alludes to the ring-shaped rashes that often appear, though no worms are involved). While most of these infections are only mildly annoying, dermatologists have begun to notice new, more concerning variants of ringworm emerging in recent years. One of these worrying newcomers is the fungus Trichophyton mentagrophytes ITS genotype VII, or TMVII. The fungus is unusual in that it seems to primarily spread through close sexual contact, something only rarely seen with other forms of ringworm.
Earlier this June, researchers at New York University Langone Health and elsewhere reported the first known U.S. case of TMVII, which had previously been confined to parts of Europe and Asia. Now the same researchers and others have detailed four more TMVII cases discovered in NYC between April and July of this year. Thankfully, all of the people infected with TMVII do appear to have been treated successfully, though some required multiple courses of antifungal medication. The team’s findings were published last Thursday in the CDC’s Morbidity and Mortality Weekly Report.
“Health care providers should be aware that TMVII can spread through sexual contact and cause lesions on the genitals, buttocks, face, trunk, or extremities,” the researchers wrote.
All five NYC cases involved cisgender men who recently had sex with other men. Two people had sex with each other, one of whom was a sex worker. Past reported clusters of TMVII have also predominantly affected men who have sex with men, though there have been cases among heterosexual men and women as well. Some research has suggested that TMVII first emerged in southeast Asia, where its transmission was likely fueled by contact with infected female sex workers.
The fungus is thought to have become endemic in Europe since it was first found in Asia. And it is certainly possible that TMVII will eventually or is already spreading locally in NYC and elsewhere in the country, the researchers say.
“We have only confirmed a small number of cases in the U.S., but it’s fair to consider the potential for local spread in the U.S. given what we know of reports from Europe. The documented cases with unclear transmission links indicate the potential for TMVII to become more than an isolated occurrence,” study researcher Avrom Caplan, a doctor specializing in autoimmune disorders of the skin at New York University Langone Health, told Gizmodo. “Endemicity [persistence] isn’t inevitable, yet given the fungus is likely transmitted through close skin contact, including sexual contact, we do need to remain vigilant.”
Caplan and his colleagues hope that their findings can push doctors, researchers, and the public to be on the lookout for the fungus moving forward—and to take proactive steps to mitigate its further spread, such as advising people with active fungal infections to avoid skin contact with others.
“The main goal of us putting this out is to make sure that clinicians and patients are aware of this new infection, which requires antifungal treatment and may be mistaken for other dermatologic conditions, especially given that this fungus may present less typically than other ringworm infections and seems to spread among sexually active individuals,” he said. “Preventive health measures focusing on awareness and early diagnosis are also important. These may be especially important in sexual health clinics or clinics where populations deemed at higher risk are seeking care.”
Unfortunately, TMVII isn’t the only emerging ringworm fungus that might become a problem for New Yorkers. Researchers have also recently discovered cases of the fungus Trichophyton indotineae in the area, which appears to not only cause more severe ringworm than usual but may also resist many common antifungal treatments.
This article has been updated with comments from one of the study’s authors.
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