Trichophyton mentagrophytes ITS genotype VII infections among men who have sex with men in France: An ongoing phenomenon

Abstract

Background

Trichophyton mentagrophytes ITS genotype VII (TMVII) has recently been identified in France as the causative agent of dermatophyte infections transmitted during sexual activity among men who have sex with men (MSM).

Objectives

Our objective was to provide new insights into the epidemiology, clinical presentation and treatment of TMVII infections based on cases diagnosed from October 2022 to September 2023 in three medical mycology laboratories in Paris. Additionally, we aimed to perform molecular characterization of TMVII strains collected in Paris, as well as in Switzerland.

Methods

We identified all isolates from skin and hair belonging to the T. mentagrophytes complex by sequencing the ITS region. For isolates corresponding to TMVII, clinical data were retrieved from medical records. For all available TMVII strains that we isolated since January 2021, we sequenced tef1α and tubb and determined the MAT locus idiomorph.

Results

We identified 32 cases of TMVII Infections. All cases occurred in men, 30 of whom reported having sex with men. Fifteen cases were sporadic cases including four among sex workers. The other 17 cases belonged to a single cluster involving a tantric masseur who infected 15 clients and his roommate. The median time from massage to lesion onset was 16 [2–52] days. Except for one patient, all other patients received systemic antifungal treatment with terbinafine. We observed five patients whose cultures remained positive even after 3–4 weeks of treatment and five patients experienced a relapse of the infection after discontinuing antifungal treatment. All French isolates exhibited identical tef1α and tubb sequences, as well as the same MAT idiomorph locus. They displayed variations in the tef1α sequence compared to isolates from Switzerland and the Czech Republic.

Conclusions

We confirm the active circulation of TMVII among MSM in France, which is associated with challenges in diagnosis, treatment and prevention.

We report 32 cases of infection by Trichophyton mentagrophytes ITS genotype VII, including a cluster of 17 cases, occurring in Paris, France between 2022 and 2023. Our findings confirm the circulation of the infection among men who have sex with men (MSM). The study highlights that the incubation period can be prolonged and is at risk of transmission. Topical antifungal treatments alone are often insufficient for achieving a cure, and oral treatments need to be prescribed for an extended duration. Additionally, patients remain contagious even after starting antifungal treatment.

Key points.

Why was the study undertaken?

• Limited knowledge exists regarding the epidemiology, clinical manifestation and management of Trichophyton mentagrophytes ITS genotype VII (TMVII) infections, despite the emergence of this pathogen as a significant concern in sexual health, particularly among men who have sex with men.

What does this study add?

• This study provides further evidence of the ongoing transmission of T. mentagrophytes ITS genotype VII (TMVII) among men who have sex with men in Paris, including sex workers. The detection of a cluster of 17 patients (16 men infected by a single masseur) is unprecedented and underscores the potential for outbreak events. Moreover, this study provides support for the possibility of a prolonged incubation period and the contagiousness during this phase.

What are the implications of this study for disease understanding and/or clinical care?

• Our results may help the management of patients infected with TMVII. We illustrate the limited efficacy of topical antifungals, and the need to use systemic antifungals often for prolonged periods, depending on the clinical and mycological response. Prolonged persistence of contagiousness under systemic and local treatment calls for appropriate transmission prevention advice.

INTRODUCTION

Dermatophyte infections are prevalent skin conditions affecting both human and animals. Transmission occurs either directly or indirectly via environmental sources. Sexual intercourse has been identified as a circumstance at risk for direct inter‐human transmission of dermatophytes. ¹ , ² , ³ We recently reported in France the occurrence of 13 cases of infections caused by a specific ITS genotype of Trichophyton mentagrophytes (ITS genotype VII or TMVII) among men who have sex with men (MSM). ⁴ The preferential locations of the lesions (genital region, buttocks and face), combined with the high‐risk profiles of the patients for sexually transmitted infections (STIs) and the association with other STIs, including two cases of Mpox, suggested transmission during sexual relations. The alternative hypothesis of zoonotic infection was considered less likely, as most of the patients had no contact with animals. Furthermore, since 2014, TMVII had been reported in cases with suspicion of sexual transmission in Europe, affecting both men and women. ⁵ , ⁶ , ⁷ , ⁸ Our study revealed that these infections could lead to severe skin lesions (kerions and nodular lesions) and were associated with long diagnostic delay and misdiagnosis. Given the limited number of cases reported, the epidemiology, clinical presentation and response to treatment of these infections remained incompletely known. The sustained nature of transmission over time was also uncertain.

To address these gaps in knowledge, we reviewed the cases of TMVII infections diagnosed between October 2022 and October 2023 in three university hospitals in Paris including a well‐documented cluster of 17 patients. We also realized extensive molecular characterization of the TMVII isolates recovered in these institutions since 2021 and selected isolates from Switzerland.

METHODS

Case description

Between October 2022 and October 2023, in the mycology laboratories of La Pitié‐Salpêtrière, Saint‐Antoine and Saint‐Louis university hospitals in Paris, all isolates identified morphologically as belonging to the T. mentagrophytes complex and isolated from skin and hair were subjected to sequencing of the ITS region using primers ITS1 and ITS4. ⁹ The sequences were aligned with the reference sequences provided in the article by Taghipour et al. ¹⁰ for ITS genotype determination. For isolates corresponding to TMVII, clinical data were retrieved from medical records. Regarding the cluster of cases associated with a masseur, patients who exhibited lesions consistent with dermatophyte infection and had been in contact with the masseur, but lacked complete or documented microbiological evidence, were considered probable cases and were included in the analysis. The patients in this manuscript have given written informed consent to publication of their case details.

Molecular characterization

All available TMVII strains isolated in Paris since January 2021 (n = 40), corresponding to the cases we previously reported ⁴ and those described in this article, had the tef1α and tubb regions sequenced as well as MAT locus idiomorph determined using previously published protocols. ¹¹ , ¹² , ¹³ , ¹⁴ Only two strains were not available for further analyses. We also performed molecular characterization of eight TMVII strains from Switzerland. ⁵ , ¹⁵ Sequences were deposited into the GenBank database. The list of the strains analysed, along with the GenBank accession numbers of the sequences, is provided in Table S1.

Antifungal susceptibility testing

Evaluation of terbinafine susceptibility was performed using terbinafine containing agar method at concentration of 0.2 μg/mL as previously described. ¹⁶

RESULTS

Case description

From October 2022 to September 2023, we identified 32 cases of TMVII infections, with 15 being sporadic cases, whereas 17 corresponded to a cluster of 16 individuals infected by a single masseur.

Sporadic cases

Fifteen cases of sporadic TMVII infection were diagnosed (Table 1). All patients were male with a median age of 29 [19–57] years. Thirteen patients reported to have sex with men and 11 declared multiple sexual partners in the month prior to lesions onset. Four patients were sex workers with a range of 30–150 partners by month. Additionally, thirteen patients reported previous STIs, including three with mpox. Four patients lived with HIV and received effective antiviral therapy and seven used HIV pre‐exposure prophylaxis (PrEP). Ten of the fifteen patients had multiple lesions whereas five had a single lesion. Lesions were predominantly located on the buttocks (n = 8), genital area (n = 7) and face (n = 6). Two patients had a kerion of the beard (Figure 1a) and two had nodular lesions (Figure 1b). Nine patients denied any contact with animals and only two had travelled outside of France in the month prior to the lesion onset. Two patients were roommates and two were partners. Screening for other STIs was conducted in nine patients, revealing Neisseria gonorhoeae infection in two cases (throat and anus). The median time between lesion onset and mycological sampling was 28 [2–91] days. Prior to mycological sampling, 10 patients had received previous antifungal, antibiotic or topical steroid treatment. After the mycological diagnosis was made, 12 patients received oral terbinafine treatment for an average duration of 42 [28–63] days. In the other three patients, therapy was not known. Notably, one patient experienced a worsening of lesions after an initial 3‐week treatment with topical ketoconazole alone (Figure 1c,d), before changing to oral terbinafine. Only one patient had a control sample taken 4 weeks after the initiation of systemic and local antifungal treatment and mycological culture remained positive. Recurrence of lesions on the same site occurred in three patients after discontinuation of oral treatment, which had lasted 1–2 months. Mycological sampling was not performed at this time and patients were subsequently treated with topical ketoconazole alone.

TABLE 1.

Fifteen sporadic cases of TMVII infections identified from October 2022 to September 2023 in Paris.

Sample date	Age	HIV/PrEP	STI history	Location of the lesions	Prior treatment	Treatment
December 2022	35	PrEP	Tp, Ng and Ct	Torso, abdomen, arm, pubis, penis and leg	tS 3 d	oTRB 28 d + tKTZ 42 d
January 2023	19	PrEP	Ng	Buttocks	0	TRB 14 d then ECZ 14 d then oTRB + ECZ 38 d
February 2023	24	PrEP	Ng and Ct	Face, arm, back, buttocks and penis	0	tKTZ 6 d then oTRB + tKTZ 28 d a
February 2023	24	PrEP	Ng, Ct and HPV	Face, back, pubis and buttocks	As needed tS then tTRB	oTRB + tKTZ 28 d
February 2023	40	ND	ND	Buttocks	ND	ND
April 2023	36	PrEP	Ng, Ct, Mpox, Ss and Pp	Pubis	tS 7 d then CPX < 7 d then tS 7 d	ECZ 6 d then tTRB 28 d then oTRB 42 d
April 2023	33	HIV	Tp, Ct, Ng and Mpox	Buttocks	0	tKTZ 14 d then oTRB 42 d
May 2023	36	PrEP	Ng and Tp	Face	CLIN 7 d	oTRB + tTRB 48 d
May 2023	57	HIV	Tp, HCV and HPV	Face, hands, feet and thighs	oTRB 5 d then tS and PRED 20 mg 49 d	ND
May 2023	29	No	Tp	Pubis, arm and leg	tS 42 d	oTRB + tKTZ 63 d
May 2023	27	ND	ND	Buttocks and legs	ND	ND
June 2023	28	HIV	Tp, Ct and Ng	Back and buttocks	tKTZ 7 d	oTRB + tKTZ 56 d a
June 2023	29	HIV	Tp, Ct, Ng and Mpox	Face, pubis, back and leg	tKTZ	oTRB + tKTZ 56 d a
June 2023	32	PrEP	Ct and Ng	Buttocks and legs	ECZ 14 d, tS 7 d	oTRB 42 d
August 2023	26	No	HPV	Face, abdomen, arm and pubis	As needed tS	oTRB + BFZ 28 d

Abbreviations: BFZ, bifonazole; CLIN, clindamycin; CPX, ciclopirox olamine; Ct, Chlamydia trachomatis; d, day; ECZ, econazole; HCV, hepatitis C virus; HPV, human papillomavirus (condylomas); NA, not applicable; ND, no data; Ng, Neisseria gonorrhoeae; oTRB, oral terbinafine (250 mg, once a day); Pp, Pthirus pubis; PRED, prednisone; PrEP, HIV pre‐exposure prophylaxis; Ss, Sarcoptes scabiei; tKTZ, topical ketoconazole; Tp, Treponema pallidum; tS, topical steroids; tTRB, topical terbinafine.

^a The patients experienced a recurrence of infection upon discontinuation of treatment and were subsequently treated locally with ketoconazole.

FIGURE 1.

Clinical appearance of sporadic cases of Trichophyton mentagrophytes ITS genotype VII infections. (a) Inflammatory lesion of the moustache (kerion), (b) erythemato‐squamous and nodular lesions of the pubis, (c) and (d) worsening of buttock lesions after 3 weeks of treatment with topical ketoconazole, with the appearance of nodules and pustules.

Cluster cases

In May 2023, we identified a cluster of 17 cases (Table 2). The index case was a 29‐year‐old PrEP‐using man with no other STI history than mpox during 2022 epidemic. He had one male sex partner in the month preceding symptoms. He worked as a tantric masseur with a colleague in Paris. Massages were exclusively for men, with both masseur and client fully naked, engaging in full body skin‐to‐skin contact. The linen on the massage table was changed after each client and washed at 60°C. Since 15 April 2023, he reported the appearance of more than 10 erythematous pruritic round plaques with squamous border on his torso, thighs and elbows (Figure 2a,b). Despite having these lesions, he continued his activity until April 27, providing massages to 19 individuals, resulting in 18 developing similar lesions according to the masseur. In addition, four patients who had been massaged before lesions appeared on the masseur also showed similar skin lesions. The earliest massage date after which lesions subsequently appeared in a client was March 25. A mycological sample of the masseur enabled the isolation of TMVII. He received oral terbinafine treatment in conjunction with topical ciclopirox olamine for 1 month. He halted his activity for 3 weeks and resumed working after the disappearance of the lesions. No new cases were detected among his clients thereafter. Of note, the roommate of the masseur presented also a single lesion on the back despite no direct body contact between them. However, they occasionally shared the same bathroom linen. The masseur colleague of the index case had no skin lesion and no cases were signalled among his clients.

TABLE 2.

Cluster of 17 cases of dermatophytosis in MSM patients related to a masseur (May–June 2023).

Case	Age	HIV/PrEP	STI history	Delay between massage and first lesions (days)	Mycological results	Treatment
Index	29	PrEP	Mpox	NA	TMVII	oTRB + CPX, 28 d
Secondary cases
Roommate
1	53	HIV	Tp, HBV, gHSV	NA	Direct examination +/culture −	CPX, 21 d
Patients massaged before the appearance of lesions in the masseur
2	57	No	No	12	TM (no sequencing)	oTRB, 28 d
3	22	No	No	19	TMVII	oTRB + FTZ, 56 d
4	26	No	No	52	TMVII	oTRB + CPX, 28 d
Patients massaged after the appearance of lesions in the masseur
5	34	No	No	26	TMVII	oTRB, 14 d
6	33	No	Ct, Ng and Pp	7	TMVII	oTRB, 56 d
7	56	No	No	20	TMVII	oTRB + CPX, 63 d
8	48	No	No	9	TMVII	oTRB + CPX, 49 d
9	53	No	No	23	TMVII	ECZ 35 d then oTRB + ECZ, 84 d
10	41	PrEP	Ct, Ng, Pp and Tp	16	TMVII	oTRB + CPX, 56 d a
11	37	PrEP	Ct, HPV and Pp	8	No sampling	oTRB, 26 d
12	25	No	No	32	TMVII	oTRB + CPX, 42 d b
13	31	PrEP	Ng, HPV, Pp and Tp	2	TMVII	oTRB + tKTZ, 28 d
14	52	No	No	11	TMVII	oTRB + CPX, 49 d
15	54	No	gHSV and Pp	17	TMVII	tKTZ 42 d then oTRB + tKTZ, 56 d
16	59	No	No	13	TMVII	oTRB, 28 d

Abbreviations: CPX, ciclopirox olamine; Ct, Chlamydia trachomatis; ECZ, econazole; FTZ, fenticonazole; gHSV, herpes simplex virus genital infection; HBV, hepatitis B virus; HPV, human papillomavirus (condylomas); NA, not applicable; Ng, Neisseria gonorrhoeae; oTRB, oral terbinafine (250 mg, once a day); Pp, Pthirus pubis; PrEP, HIV pre‐exposure prophylaxis; tKTZ, topical ketoconazole; TM, Trichophyton mentagrophytes; TMVII, Trichophyton mentagrophytes ITS genotype VII; Tp, Treponema pallidum; tTRB, topical terbinafine.

^a The patient had already been treated for a month with oral terbinafine and ciclopirox olamine cream before the recurrence of infection.

^b The patient had already been treated for 2 weeks with oral terbinafine and isoconazole + diflucortolone cream before the recurrence of infection.

FIGURE 2.

Clinical lesions in a cluster of 17 Trichophyton mentagrophytes ITS genotype VII infections linked to a single masseur. (a, b) Erythemato‐squamous circinate lesions on the torso and elbow of the masseur, (c–e) erythemato‐squamous circinate lesions on the buttocks in three different clients of the masseur, (f) exudative lesion on the finger of a client and (g, h) low inflammatory lesions on the buttocks in two patients who relapsed after discontinuation of treatment.

From the 24 potential secondary cases corresponding to the clients and the roommate, we were in contact with 16 of them. All were MSM, with a median age of 44.5 [22–59] years. One lived with HIV and three were PrEP users. Five had multiple sexual partners in the month preceding the onset of the lesions. The median interval between the massage and symptom onset was 16 [2–52] days. Eleven patients had more than 10 lesions, predominantly located on the buttocks (n = 12), a region that was massaged by the index case using his elbows, and thighs (n = 13) (Figure 2c–e). Two patients exhibited nodular lesions while another presented one highly inflammatory exudative lesion (Figure 2f). Mycological examination of 15 patients revealed T. mentagrophytes in 14 cases. Although direct examination was positive in one instance, the culture remained negative. Subsequent sequencing of the ITS region for the 13 available isolates identified TMVII in all cases.

Fifteen patients were prescribed oral terbinafine while one patient received only topical ciclopirox olamine therapy. The median duration of oral terbinafine treatment was 49 days [14–84]. Among the 11 patients sampled for therapy follow‐up, four remained culture‐positive 3–4 weeks after the initiation of treatment. All six mycological samples taken after 2 months of treatment were negative in culture. Two patients initially received only local treatment for 5–6 weeks, resulting in clinical and microbiological failure. One of them developed nodular lesions in the meantime. Two patients initially treated with oral terbinafine for 2 and 4 weeks, respectively, and clinically cured, had active mildly inflammatory lesions one month after stopping treatment (Figure 2g,h). They were cured after a second course of oral terbinafine. No secondary cases were identified in the immediate contacts of the patients.

Molecular analysis

ITS, tef1α and tubb sequences were identical for all the 40 sequenced strains isolated in Paris since march 2021. The sequences were also similar to those of five strains from Switzerland. However, tef1α sequences differed by one base for three sequences of strains isolated in Switzerland between 2014 and 2016 (14060459, 14070039 and 16031204). MAT 1‐2‐1 was amplified in all strains, while the MAT 1‐1‐1 was not detected in any of them.

Antifungal susceptibility testing

While the control plate was positive in all the cases, none of the 40 strains grew on medium containing 0.2 μg/mL terbinafine.

DISCUSSION

This series of 32 cases (15 sporadic cases and a cluster of 17 cases) confirms the ongoing circulation of TMVII within the MSM population in Paris. In total, since March 2021, 45 cases of TMVII infection have been reported in Paris, including the 13 previously reported cases. ⁴ We have not yet identified any case in women in Paris. These cases only represent those identified by three mycology laboratories in Paris. This is not a comprehensive count of cases, which are likely much more numerous both in and outside of Paris. The possibility of recruitment bias cannot be disregarded.

Regarding sporadic cases, the high‐risk STI profile of the patients (including multiple sexual partners and previous history of STIs), along with the predominant locations of the lesions (genital area, buttocks and face), mirrored those reported in our previous article, ⁴ supporting the hypothesis of sexually transmitted dermatophytosis. Interestingly, at least six out of 28 (21.4%) sporadic cases of the two studies had mpox, suggesting an overlap between the populations affected by TMVII infections and by the 2022 mpox outbreak. ¹⁷ Two patients presented with kerion of the beard, confirming it as a severe clinical presentation of TMVII infection often misdiagnosed as a bacterial infection. ⁴ Additionally, one patient had nodular lesions in the pubic region, which were linked to intimate shaving, as previously suggested as a risk factor for severe deep skin lesions. ⁵ , ⁷ , ¹⁸ Diagnostic difficulties were illustrated by prolonged delays between lesion onset and mycological sampling, as well as inappropriate prescriptions of antibiotics and topical steroids. ⁴

As far as we know, this is the first report of dermatophyte transmission during massages, despite the risk being previously identified. ¹⁹ Tantric massages, as practiced by the masseur in the cluster, are likely to pose a particular risk of dermatophyte transmission for both clients and professionals. Henceforth, the notion of massage should be searched as a risk factor for tinea corporis. The clients of the masseur exhibited a stereotyped clinical presentation, with a predominance of lesions on the buttocks and legs, consistent with the massage practices. However, three of them had more severe lesions (nodular or exudative lesions), highlighting inter‐individual variation in clinical presentation.

Knowing the date of the massage allowed us to estimate the incubation period of the infection, whereas in sporadic cases, the infection date is rarely identified. The dermatophyte infection incubation is usually reported to be between 4 and 14 days. ²⁰ The median incubation period observed in our study was 16 days, with a wide range of time between 2 and 52 days. While the declarative and retrospective nature of data collection may have led to an overestimation of the incubation period, these findings suggest considering longer incubation periods when identifying the timing of infection.

Despite receiving massages from the masseur in the 3 weeks preceding the identification of lesions on his skin, three clients were infected with TMVII. This indicates that the masseur might have been contagious during the incubation period. In experimental T. mentagrophytes infections in humans, cultures were positive at the site of inoculation even when clinical symptoms were minimal or absent. ²¹ Furthermore, Küçükgöz‐Güleç et al. ²² documented the isolation of Arthroderma vanbreuseghemii from an inguinal skin sample before any visible skin manifestations appeared. These findings suggest that the incubation period poses a risk of transmission, potentially contributing to the perpetuation of the infection circulation.

The transmission of the infection through massages further confirms the effective human‐to‐human transmission of TMVII. The identification of a cluster of 17 cases illustrates the propensity of TMVII to generate outbreaks. The isolation of TMVII in four sex workers is a matter of concern, as they could equally transmit the infection to a large number of clients. TMVII infection cases have already been associated with intercourse with sex workers. ⁵ , ⁶ The absence of contact with animals for 9 of 15 patients with sporadic infection does not support the alternative hypothesis of zoonotic infection. Furthermore, we recently sequenced the ITS region of 295 T. mentagrophytes isolates from French veterinary samples without identifying any TMVII isolate, ²³ indicating that this genotype probably does not circulate among domestic animals in France.

Whereas recommended first line treatment of tinea corporis, at least for localized lesions, is topical antifungal treatment for 2–4 weeks, ²⁴ all the patients, except one, were eventually treated with oral terbinafine. Local treatment was associated with failure or worsening of the lesions even for localized lesions advocating for oral treatment from the outset. Oral treatment was extended over several weeks based on clinical and mycological response. Five patients tested positive for dermatophyte culture up to 4 weeks into treatment. Kupsch et al. ⁷ had already reported prolonged positive cultures lasting up to 8 weeks during treatment of TMVII infections. Contagiousness could therefore persist for several weeks during treatment. This information should be considered in the prevention of infection transmission. The recurrence of infection after discontinuation of treatment in five patients also underscores the importance of a systematic patients review after 3–4 weeks of initial and extended treatment to assess clinical and mycological response. Nevertheless, no true clinical failure of terbinafine treatment has been identified and no high‐level terbinafine in vitro resistance was detected in isolates. The existence of low‐level resistance to terbinafine, which could have impacted the treatment response, cannot be ruled out.

The sequencing of tef1α and tubb from 48 strains of T. mentagrophytes genotype ITS VII revealed two distinct populations sharing the same ITS sequence. The tef1α sequence of three Swiss strains (14,060,459, 14,070,039, and 16,031,204), isolated from patients returning from Southeast Asia, ⁵ differed by one base from the sequence of all other strains. These sequences are identical to those reported by Švarcová et al. ¹⁴ in the Czech Republic (CCF 6580 and D374/15). The tef1α sequences of the other sequenced strains were identical to the four sequences reported by Nenoff et al. ⁸ for infections diagnosed in Germany (MK460545, MK467448‐MK467450), none of which was associated with a stay in Southeast Asia. They were also identical to the sequences of two strains isolated in Berlin (PP444707, PP444708). ⁷ Therefore, the cases in Europe may be independent of those imported from Southeast Asia. New studies with more strains of diverse origins would provide a better understanding of the respective epidemiology of the infections caused by these two populations of strains while wide genome sequencing of the strains would offer a clearer understanding of their relatedness.

All 48 strains tested share the same mating type idiomorph (MAT 1‐2‐1) similarly to 30 Berlin strains and two Czech Republic strains which were previously tested. ⁷ , ¹⁴ The identification of a single idiomorph mating type, along with no or minimal genetic differences in sequenced gene among these strains, supports the theory of a clonal lineage without mating. This is consistent with exclusive human‐to‐human transmission. In comparison, the entire T. mentagrophytes lineage displays the presence of both mating types as demonstrated in a study from Czech patients where 14 out of 39 T. mentagrophytes strains isolated from human lesions showed MAT 1‐1‐1, and 25 showed MAT 1‐2‐1 gene idiomorph. In contrast, only the MAT 1‐2‐1 gene was found for anthropophilic T. interdigitale and T. indotineae isolates. ¹⁴

This series of cases confirms that dermatophytes should be considered as STI agents as other skin and hair pathogens such as scabies or Pthirus pubis as well as monkeypox virus. ²⁵ Between 2014 and 2019, TMVII infections with suspicion of sexual transmission were described in both men and women. ⁵ , ⁶ , ⁷ , ⁸ However, three recent reports from Berlin, Vienna and New‐York have specifically highlighted sexually transmitted dermatophytosis in MSM patients, indicating that the circulation of TMVII in this population may extend beyond Paris. ²⁶ , ²⁷ , ²⁸

This series illustrates the current challenge posed by TMVII infections. Clinicians and patients at risk should be aware of these infections to facilitate appropriate treatment and prevent transmission. Mycological sampling plays a crucial role in achieving an accurate diagnosis and documenting the phenomenon. Antifungal oral treatment appears to be indicated even in cases of limited lesions and should be prolonged based on clinical and mycological response. Transmission prevention recommendations must be provided. Further studies are necessary to gain a better understanding of the extent of the phenomenon, which likely affects already several countries, especially in the context of a rise in bacterial STIs. ²⁹

AUTHOR CONTRIBUTIONS

A. Jabet: conceptualization, investigation, data curation and writing – original draft preparation. V. Bérot: conceptualization, investigation and writing – original draft preparation. T. Chiarabini: investigation and writing – reviewing and editing, S. Dellière, P.P. Bosshard, M. Siguier, R. Tubiana, M. Favier, A. Canestri, S. Makhloufi, A. Nouchi, T. de Risi‐Pugliese, F. Boquel, G. Crémer, R. Khouri, O. Sidali, S. Hamane, M. Benderdouche, M. Palous, F. Chasset, Y. Gräser and V. Hubka: investigation and writing – reviewing and editing. A. Fekkar and C. Hennequin: supervision and writing – reviewing and editing. R. Piarroux: conceptualization, supervision and writing – reviewing and editing. A‐C. Normand: conceptualization, investigation and writing – reviewing and editing. G. Monsel: conceptualization, investigation, supervision and writing – reviewing and editing.

FUNDING INFORMATION

No specific funding.

CONFLICT OF INTEREST STATEMENT

The authors have no conflicts of interest to declare.

ETHICAL APPROVAL

This study is observational and does not involve any experimentation on human subjects or animals.

ETHICS STATEMENT

The patients in this manuscript have given written informed consent to publication of their case details.

Supporting information

Table S1:

Jabet A, Bérot V, Chiarabini T, Dellière S, Bosshard PP, Siguier M, et al. Trichophyton mentagrophytes ITS genotype VII infections among men who have sex with men in France: An ongoing phenomenon. J Eur Acad Dermatol Venereol. 2025;39:407–415. 10.1111/jdv.20439

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions.