TMVII For Health Professionals

On this page:
History of Present Illness
Diagnosis
Treatment
Counseling
Reporting
Resources

History of Present Illness

Consider dermatophyte infection in patients with itchy, painful, and/or persistent perioral, perianal, or genital skin rashes.

Skin rash appearance might vary, but can include sharply demarcated, erythematous, scaly, pruritic plaques or pustules.

Take a detailed exposure and treatment history. Has the patient:

• Had a sexual partner or household member with similar rashes or suspected/confirmed TMVII infection?
• Had any recent out-of-state travel?
• Engaged in group sex or sex work?
• Been to any of the following venues in the month before rash onset: public shower, public pool, public sauna or steam room, or bath house?
• Received prior treatment for the rash based on another diagnosis (e.g., eczema, psoriasis, folliculitis, or tinea)?
• Used over-the-counter or prescription antifungal or steroid creams for their rash? 

Diagnosis

Confirming TMVII diagnosis requires molecular sequencing of a fungal isolate. The MDH Public Health Laboratory is facilitating testing through Wadsworth Center in New York.

• Confirm dermatophyte infection with KOH microscopy, if available.
• Collect skin scraping and/or biopsy from the rash for fungal culture.
  • Note: If a clinical laboratory is not available, or the laboratory is unlikely to save fungal isolates, specimens can be sent directly to MDH for fungal culture.
• Send fungal isolates from suspect TMVII cases to the MDH Public Health Laboratory (MDH-PHL).
  • Complete the lab submission form for specimens or fungal isolates: Infectious Disease Laboratory Submission Form (PDF).
• Screen patients for other sexually transmitted infections and discuss partner notification and screening.

Suggested protocol for specimen collection: 

• Gather equipment, including alcohol wipes, gloves, straight edge (scalpel, tongue depressor, or microscope slide), sterile specimen container, patient label.  
• Use gloves as standard precaution.
• Clean skin with alcohol wipe and allow to dry.
• Stretch skin and hold scalpel or tongue depressor perpendicular to rash. Scrape the skin surface to remove overlying scale from the edge of the rash.
• For hair-bearing rashes, pluck hairs with intact roots from the edge of the rash.
• Collect material in sterile specimen container and attach patient label.
• Send specimen to clinical laboratory for fungal culture.

Treatment

• Treat suspected TMVII infection empirically with oral terbinafine (250mg daily). Do not delay treatment because of lack of KOH microscopy or fungal culture results.
• Treatment generally lasts six to eight weeks but could last up to 12 weeks.
• Continue treatment for two weeks after clinical resolution to prevent recurrence as TMVII often persists in hair follicles.
  • Residual hyperpigmentation might make it challenging to determine resolution. Continuing oral therapy for approximately two weeks beyond symptom resolution (pain, pruritus) is advised to ensure complete cure.
• Topical antifungals are not recommended as monotherapy at this time because they do not effectively penetrate the hair follicle.
• Use of topical corticosteroid creams is not recommended as it might mask symptoms, resulting in prolonged and worsened infection.

Counseling

Counsel patients on the need for prolonged therapy and importance of adherence to the medication with follow-up. This is important as TMVII infections are generally susceptible to oral terbinafine; however antifungal resistance has been reported among other Trichophyton species.

Counsel patients on strategies to prevent transmission of, or reinfection with, dermatophyte infections, including:

• Avoiding sexual contact while experiencing symptoms
• Avoiding skin-to-skin contact with a rash
• Avoiding shared use of person items and clothing
• Washing and drying clothing on high heat to kill fungal spores
• Avoiding use of over-the-counter steroid creams.

Reporting

Fill out the short TMVII Reporting Form or call MDH epidemiology at 651-201-5414 to report all suspect or confirmed cases of TMVII to MDH.

To date, there have been no documented invasive or systemic TMVII infections, including in patients that are immunocompromised. However, because this is an emerging infection and key aspects are still being studied, providers are encouraged to report any unusual or severe manifestations to MDH.

Resources

• MDH: TMVII Information for Providers (PDF)
• CDC: Recent dermatophyte (ringworm) cases associated with sexual contact
• NYC: MMWR Notes from the Field: Trichophyton mentagrophytes Genotype VII
• American Academy of Dermatology: Trichophyton mentagrophytes genotype VII and other emerging dermatophytes of concern
• MDH: Forms for the Infectious Disease Laboratory. Contains information on submitting specimens to the MDH Infectious Disease Laboratory.