Health Update: Trichophyton mentagrophytes genotype VII (TMVII)

Disease Prevention and Control

Situational updates

Two cases of Trichophyton mentagrophytes genotype VII (TMVII), an emerging dermatophyte infection, have been identified in San Francisco. The first was reported in March 2025 and the second was reported in December 2025. Both patients were male, and neither reported contact with a known TMVII case or recent international travel. This health update describes the clinical presentation, epidemiology, diagnosis, and treatment of TMVII.

TMVII presents as an extensive or severe rash that is inflamed, painful, or pruritic, frequently involving the genital region, buttocks, or face, and it may not respond to standard topical antifungal treatment. TMVII is often spread through skin-to-skin or intimate, often sexual, contact. It can also be spread through sharing of clothing, towels, and bedding. Epidemiologic risk factors include intimate contact with individuals with signs or symptoms of a TMVII infection and association with a sexual network or venue with TMVII infections. TMVII has been circulating in Europe for several years, primarily within sexual networks among men who have sex with men (MSM). Some cases have also been associated with sex tourism in Southeast Asia. The first U.S. TMVII case was reported in an individual in New York City in June 2024, followed by additional cases there and elsewhere in the U.S.

Potassium hydroxide (KOH) preparation can identify the presence of fungal elements and fungal culture can identify Trichophyton species, but definitive diagnosis requires genotyping. SFDPH can facilitate transport from your clinical laboratory to the following reference laboratories for this testing:

Empiric treatment with oral terbinafine is typically effective for TMVII infections, but some patients may require itraconazole.

Actions requested of SF clinicians:

  • Suspect TMVII in patients presenting with inflammatory, painful, or persistent skin lesions affecting the genitals, buttocks, or face, especially if severe/extensive or not responding to topical antifungal therapy, or fungal elements are identified on KOH preparation.
  • Diagnose TMVII by collecting skin scrapings in a sterile container for fungal culture. If a Trichophyton species is confirmed by culture, please contact SFDPH (contact information below) for assistance in submitting the sample to a reference laboratory for genomic sequencing.
  • Report suspected or laboratory-confirmed TMVII cases to SFDPH (628-217-6100).
    • If TMVII is suspected, consider empiric treatment with oral terbinafine 250 mg once daily until the infection has resolved.
  • Share preventive guidance with patients with suspected or laboratory-confirmed TMVII:
    • Avoid skin-to-skin or intimate contact until the rash has resolved.
    • Notify recent sexual contacts and household contacts and advise to seek care if a rash develops.
    • Avoid sharing personal items and clothing.
    • Wash and dry fabrics on high heat to kill fungal spores.

Additional Resources:

Program Contact Information

Communicable Disease Branch
Population Health Division | San Francisco Department of Public Health
Tel: (628) 217-6100 | Email: cdcontrol@sfdph.org

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