New & Emerging STIs

Overview

Trichophyton mentagrophytes type VII (TMVII) is a fungal skin infection that spreads through close skin-to-skin and sexual contact. It was first identified in 2014 in Europe, with the current variation (TMVII) seen first in 2018. The first case was reported in the United States in June 2024. Most cases have been among men who have sex with men (MSM).

Symptoms

TMVII presents as inflamed skin, often with a ring shape, near the genitals, buttocks, face, or other regions. It may appear reddened on lighter skin or grey, violet, or dark brown on darker skins. These lesions are persistent without treatment, and scarring may form. The infection may itch or cause pain.

Treatment

TMVII is treated with several weeks of oral antifungal medication. Other forms of treatment, such as topical medication, may also be used but are not sufficient on their own. Formal diagnosis, through taking a sample of the skin and sending it for culture, is slow and not available at most labs. A health care provider may use other forms of testing to help guide treatment.

Prevention

Prevention of TMVII includes avoiding skin-to-skin or sexual contact until the rash resolves. Additionally, all shared surfaces should be disinfected and personal items such as clothing, bedding, sex toys, or eating utensils should not be shared. Someone with a suspected case of TMVII should continue treatment as prescribed and seek follow up appointments until the rash improves.

Overview

Mpox is a rash causing viral disease which spreads by close contact with infected individuals or animals.

It was first identified in 1958 at a primate research facility. Then, in 1970, the first known human infection occurred in Sierra Leone. U.S. outbreaks occurred in 2003 and 2022. Mpox is currently most prevalent in central and east Africa. 

Incidence

Both men and women can be infected. Since the disease is often spread through sexual activity, those at highest risk include people with multiple sex partners, men who have sex with men (MSM), and those who participate in group sex or sex work. Other at-risk groups include health care workers, those who work with small mammals or rodents, and those who have resided in or traveled to endemic areas. 

Transmission

Mpox spreads to humans from infected animals or infected humans.

Animal spread occurs when an infected animal bites or scratches a human, or someone handles the meat of an infected animal.

Spread occurs to humans by sexual activity or close contact. The virus spreads through body fluids (blood, saliva, semen, vaginal fluid, rectal fluids, blood, breastmilk). It also spreads by contact with the mpox rash or contact with contaminated objects (like towels or shared kitchen utensils).

Mpox is contagious from the beginning of symptoms until the resolution of the rash. 

Symptoms

Symptoms appear 1-3 weeks after exposure to mpox. Initial symptoms include swollen lymph nodes, fever, headache, or muscle aches. Some people have no noticeable early symptoms. Then, 1-3 days later, a rash appears, which may cause pain. The rash evolves from small bumps to fluid filled blisters. These scab over within a few weeks. The rash may itch, especially in later stages. After scabs fall off, new skin appears. The mpox rash may appear on hands, feet, mouth, genitals, or other body parts.

Complications

Often, mpox resolves without further complications.

Complications that may occur include bacterial infection of the rash, damage to the eyes and possible vision loss, pneumonitis or pneumonia, encephalitis (inflammation of the brain), or dehydration.  

Diagnosis

Mpox is suspected when characteristic symptoms and rash appear — especially if someone has traveled to regions highly affected, participated in high-risk sexual activity, or been in contact with an infected individual. A health care provider can diagnose monkeypox by swab of the rash and laboratory testing.

Treatment

In most cases, mpox treatment is supportive. In other words, treatment focuses on decreasing pain and discomfort.

Antiviral medications may be used for complicated cases (such as those with eye involvement) or for those at highest risk for poor outcomes. These vulnerable populations may include children, pregnant women, immunocompromised individuals (such as those living with HIV), or people with underlying skin conditions.

Prevention

A vaccine is available for those at high risk for exposure or those already exposed to monkeypox.

If someone has a known infection, they should cover rash sites and follow public health regulations to avoid spread to others. This may include temporary isolation. Health care providers or caregivers should wear appropriate personal protective equipment (gowns, goggles, and gloves).