Trichophyton mentagrophytes genotype VII (TMVII)

Actions requested

• Medical providers should be aware that Trichophyton mentagrophytes genotype VII (TMVII) is a dermatophyte fungus that can be transmitted through skin-to-skin contact, including through sexual contact. TMVII can cause a tinea infection (ringworm) which typically presents with pruritic, well-demarcated, annular scaly lesions on the genitals, buttocks, face, trunk or extremities. These are sometimes mistaken for eczema or psoriasis.
• Clinicians evaluating patients for possible TMVII should obtain skin scrapping for fungal culture and/or polymerase chain reaction (PCR) testing if that testing is available. The definitive diagnosis of TMVII requires fungal culture with molecular sequencing of the fungal isolate or PCR testing. PCR testing and culture with molecular sequencing for TMVII can be performed at the University of Washington Microbiology Laboratory but is not currently available through local commercial laboratories. Insofar as testing is available, Public Health recommends that clinicians test patients for TMVII if they present with anogenital ringworm or have ringworm at another anatomic site and have a sex partner with anogenital ringworm or confirmed TMVII. PCR is the preferred test for TMVII since it is more sensitive and provides results more quickly than fungal culture, though it is also more expensive and does not provide fungal susceptibility information. Persons with possible TMVII can be evaluated and tested at the Public Health – Seattle & King County Sexual Health Clinic at Harborview Medical Center.
• Confirmed or suspected cases of TMVII should be treated with oral terbinafine (250mg daily).  Topical treatments are not consistently effective against TMVII. Medical providers should initiate terbinafine therapy in suspected cases without awaiting fungal culture or PCR results. Treatment should typically be continued for 6-8 weeks but may be required for up to 12 weeks. Patients should continue therapy until 2 weeks after resolution of symptoms (e.g., pruritus, pain).
• Medical providers should ask patients with possible or confirmed TMVII about recent sexual exposures and symptoms in their sex partners and should advise patients with suspected TMVII to avoid skin-to-skin contact with affected areas (including during sex) or sharing of personal items (e.g., razors, towels, bedding, cloths) until their symptoms have resolved. Providers should advise patients that their symptomatic sex partners should seek medical evaluation. People with TMVII should wash their hands after touching TMVII rashes and be aware that TMVII can affect pets, leading to localized hair loss or irritated skin in the infected animal; potentially affected pets should be evaluated by a veterinarian.  
• Medical providers should test patients with possible or confirmed TMVII for syphilis and HIV (if not already known to be HIV positive) and offer them HIV pre-exposure prophylaxis (PrEP) (if HIV negative) and doxyPEP.