The New Sexually Transmitted Ringworm That Doctors Are Struggling to Recognize

In February 2026, Minnesota health officials issued an urgent public advisory declaring the state was experiencing the largest known outbreak in the United States of a sexually transmitted fungal infection called TMVII. Most people had never heard of it. Most doctors had never seen it. And the rash it causes looks so much like eczema, psoriasis, or jock itch that it had been quietly spreading through sexual networks for months before anyone connected the dots. This article covers what TMVII actually is, how to recognize it, why it keeps getting missed, and what to do if you think you've been exposed.

TMVII, Trichophyton mentagrophytes genotype VII, is the only known sexually transmitted fungal infection in the world. It causes painful, coin-shaped ringworm rashes on the genitals, buttocks, legs, face, and trunk, spreads through direct skin-to-skin contact during sex, and requires oral antifungal treatment for up to three months to fully clear. A topical cream will not fix it, and using the wrong treatment can make it worse.

What Just Happened in Minnesota

On February 11, 2026, the Minnesota Department of Health issued a formal health advisory after identifying more than 30 confirmed or suspected cases of TMVII concentrated in the Twin Cities metropolitan area. The first Minnesota case was confirmed in July 2025, when a patient sought care for a genital rash that wouldn't respond to standard treatment. By February 2026, the cluster had grown large enough that state officials declared it the nation's largest known TMVII outbreak, and issued alerts to hospitals, clinics, urgent care centers, dermatologists, and emergency departments across the state to watch for it.

Minnesota wasn't the starting point. The first US case was identified in New York City in June 2024 in a man who reported multiple male sexual partners while traveling in Europe. By October 2024, the CDC had published a formal report in the Morbidity and Mortality Weekly Report documenting those early New York cases. San Francisco confirmed two cases by January 2026, both male patients with no contact with known TMVII cases and no recent international travel, meaning domestic transmission was already happening independently of travel history. Scattered cases have since been identified in other major US cities. A 2025 study published in Emerging Infectious Diseases found that among 117 polled infectious disease clinicians, only a minority had experience diagnosing or treating TMVII, meaning the gap between cases occurring and cases being correctly identified is almost certainly significant.

The reason the Minnesota cluster became so large before detection is the same reason TMVII is spreading in the first place: the infection is new enough that most clinicians don't think to look for it, and the rash it produces is common-looking enough that patients and providers alike assume something more familiar is going on. A round, red, itchy rash near the genitals is easy to write off as jock itch, an allergic reaction, or eczema. By the time a patient cycles through a topical treatment that doesn't work and returns to a provider who considers alternative diagnoses, the infection has had weeks to spread further.

What TMVII Is, And Why It's Different From Regular Ringworm

Ringworm is not caused by a worm, it's a fungal skin infection caused by a group of organisms called dermatophytes. The "ring" in ringworm refers to the circular shape of the rash, which has a raised, slightly darker edge around a clearing center. Jock itch, athlete's foot, and nail infections are all caused by related dermatophyte species. Most ringworm infections respond well to over-the-counter topical antifungal creams within a few weeks. TMVII does not.

What makes TMVII distinct is a combination of factors that make it both harder to treat and more likely to spread. The infection is caused by a specific genotype, genotype VII, of Trichophyton mentagrophytes, a species that has existed for a long time but whose genotype VII variant appears to have only recently begun circulating among humans through sexual contact. Genotype VII does not respond reliably to topical antifungals the way standard ringworm does. The fungal spores penetrate more deeply into the skin, and without systemic oral treatment, the infection persists, spreads to new areas of the body, and can cause scarring and secondary bacterial infections if left untreated.

The transmission profile also sets it apart. Standard ringworm spreads through casual skin-to-skin contact, contaminated surfaces, and animal contact. You can pick it up from a gym mat or a shared towel. TMVII does all of that too, but its primary transmission route is sexual contact. The close, sustained skin-to-skin contact involved in sex creates ideal conditions for the fungus to transfer from one person's active rash to another person's skin. Fungal spores can also survive on shared objects, towels, bedding, clothing, and sex toys, which means transmission doesn't require direct genital contact. According to the CDC's February 2026 clinician brief on emerging ringworm, TMVII is the only identified fungal organism that functions as a sexually transmitted infection.

What the Rash Actually Looks Like, And Why It Gets Missed

You notice a round, red patch near your inner thigh a week or two after a sexual encounter. It's slightly raised at the edge, a little itchy, not dramatically painful yet. It looks exactly like jock itch, or maybe a heat rash, or a friction irritation. You pick up an antifungal cream at the pharmacy. A week later, it's still there. Maybe slightly bigger. You use more cream. It doesn't clear. At this point, weeks have passed and the infection has likely spread to adjacent skin.

That scenario is why TMVII has spread as far as it has. The rash it produces is clinically indistinguishable from several common skin conditions without laboratory testing. Characteristics of a TMVII rash include round, coin-shaped lesions with red, irritated edges; bumps or pimples on top of the lesion; potential involvement of the genitals, buttocks, perianal area, inner thighs, abdomen, legs, arms, or face; and, in more advanced or untreated cases, pain, blistering, crusting, and scarring. The infection can appear on the face, including around the mouth, which patients rarely connect to sexual transmission because the face is not where they expect an STI to show up.

Two features drive misdiagnosis. First, the appearance at onset closely mirrors eczema and psoriasis, both of which are treated with topical corticosteroid creams. Applying a corticosteroid to a TMVII infection actively worsens it, because corticosteroids suppress the local immune response that would otherwise help contain the fungus, allowing it to spread more aggressively. Second, standard topical antifungal treatments that work on jock itch do not work on TMVII. A patient who tries an over-the-counter antifungal, sees no improvement, and concludes the rash must be something non-fungal is in exactly the wrong diagnostic frame to catch TMVII correctly.

The single most reliable early indicator that a rash might be TMVII rather than one of its lookalikes is treatment response, or rather, the lack of it. A rash that does not improve after two weeks of topical antifungal treatment, or that worsens after corticosteroid application, warrants evaluation for TMVII at a sexual health or dermatology clinic.

How TMVII Spreads and Who Is Currently Most at Risk

TMVII spreads primarily through direct skin-to-skin contact with an active rash during sexual activity. Because the fungal lesions can appear anywhere on the body, including the face, abdomen, and legs, the transmission risk extends beyond genital contact. Any part of your skin that touches an active TMVII rash during sex is a potential entry point, because the fungus transfers via spore contact with intact or minimally compromised skin.

Beyond direct sexual contact, TMVII spores survive on surfaces and objects. Shared towels, bed linens, clothing, and sex toys have all been identified as potential transmission routes in the epidemiological data. This makes household transmission possible between partners even during periods when one person is avoiding sexual contact due to symptoms, if linens aren't washed on high heat and personal items aren't kept separate, reinfection or transmission can continue after the initial sexual contact has stopped.

The current US outbreak has occurred predominantly among men who have sex with men, which reflects the population where TMVII was first identified and where active surveillance has been most concentrated. The Minnesota Department of Health specifically lists MSM, people who use anonymous dating apps, and people with a history of previous STIs as the groups currently at highest risk. However, infectious disease specialists at Duke Global Health Institute have been explicit that anyone can contract TMVII regardless of gender, sexual orientation, or relationship structure; the risk is tied to skin contact with an active rash, not to identity. The current concentration in MSM networks reflects where the infection entered the US and how sexual networks are structured, not any biological predisposition.

Testing for TMVII, And the Other Infections That Travel With It

TMVII itself is diagnosed clinically and confirmed through laboratory testing, not through a standard at-home STI test. A healthcare provider at a sexual health or dermatology clinic will scrape a skin sample from the active rash, examine it under a microscope to identify fungal elements, and attempt a fungal culture to isolate the organism. DNA sequencing to confirm the TMVII genotype can take additional weeks, which is why Minnesota health officials and the CDC recommend that clinicians begin empiric treatment based on symptoms and risk context rather than waiting for full laboratory confirmation.

What at-home testing does cover, critically, is everything else that travels alongside TMVII. The people most at risk of TMVII right now are sexually active people with recent new partners, and that same exposure history is precisely the situation that warrants comprehensive STI screening. TMVII does not show up on a standard STI panel, but HIV, syphilis, gonorrhea, chlamydia, and hepatitis do, and co-infection rates among people diagnosed with one STI are consistently higher than in the general population. Catching a co-infection early is just as important as identifying TMVII itself.

The timing for each infection matters. Test for HIV at 6 weeks after potential exposure for a first indicator result; a negative at 6 weeks is meaningful, but retest at 12 weeks for certainty. A confirmed negative at 12 weeks means you did not contract HIV from that exposure; a positive means the virus is present and you should connect with a healthcare provider immediately. Test for syphilis from 6 weeks after exposure; the antibody response takes time to develop, and testing before 6 weeks risks a false negative. Test for chlamydia from 14 days after exposure and gonorrhea from 3 weeks after exposure. For herpes HSV-1 and HSV-2, test from 6 weeks after exposure. For hepatitis B, test from 6 weeks after exposure. For hepatitis C, test from 8 to 11 weeks after exposure; testing before 8 weeks carries a real risk of a false negative result, and a negative after 11 weeks is considered conclusive.

A negative result for any of these infections at the correct window means no infection from that exposure was detected, relief, with a clear baseline. A positive result means an infection is present and treatment or management can begin immediately. The 7-in-1 Complete At-Home STD Test Kit screens for HIV, syphilis, HSV-2, chlamydia, gonorrhea, hepatitis B, and hepatitis C in a single session. Time your test at 6 weeks post-exposure and all infections with a 6-week window are covered accurately in one go. For the most complete panel available for women, the Women's 10-in-1 At-Home STD Test Kit adds HPV and trichomoniasis. Results in about 20 minutes, no clinic visit required. Your results, your privacy, your power.

What to Do If You Think You Have TMVII

If you have a rash near your genitals, buttocks, inner thighs, or face that appeared within days to a few weeks of sexual contact with a new partner, and the rash is not clearing with standard topical antifungal cream after two weeks, seek evaluation at a sexual health clinic or dermatology provider. Do not apply corticosteroid cream; products like hydrocortisone will worsen TMVII by suppressing the local immune response that is partially limiting the infection's spread, and will make the rash look temporarily better while allowing the underlying fungal infection to advance.

While you have an active rash, avoid sexual contact and skin-to-skin contact with others. Wash all clothing, towels, and bed linens on high heat to kill fungal spores on fabric. Do not share towels, razors, or sex toys. If you have a regular partner or recent sexual contacts, notify them so they can be evaluated. TMVII can be present and spreading from a rash even before it becomes painful enough to prompt medical care, and partners may be infected without knowing it yet.

Treatment requires oral antifungal medication prescribed by a healthcare provider; the specific agent and duration depend on the severity of the infection and how it responds. Treatment courses range from six weeks to up to three months. Completing the full course is essential; stopping early when the rash appears to clear risks relapse, because the fungal spores can remain viable in the skin even when visible symptoms have resolved. Do not test at-home STI kits for TMVII; no such test exists. Evaluation requires in-person clinical assessment and laboratory confirmation at a healthcare facility.

Why This Is Happening Now, And What It Tells Us About Emerging STIs

TMVII was first identified as a human pathogen in 2023, primarily among men who had traveled in Southeast Asia. The initial European cases indicated that the genotype had been circulating unnoticed prior to formal characterization, likely misidentified as typical ringworm or resistant jock itch. The global sexual network, which dating apps helped people connect with each other across cities and countries, made it possible for a skin-contact pathogen to spread much faster than historical STI patterns would have suggested.

The Minnesota outbreak illustrates a dynamic that public health officials have warned about for years: emerging infections enter a new geography through high-connectivity networks, establish local transmission, and spread significantly before surveillance systems catch up. TMVII is not a reportable infection in most US states, which means there is no mandatory case-counting system tracking how widely it has spread. The Minnesota cluster was identified because alert clinicians recognized an unusual pattern and proactively contacted the health department, not because a surveillance system flagged it. In places where that clinical alertness doesn't exist, TMVII cases are almost certainly being logged as treatment-resistant jock itch or unspecified dermatitis and never investigated further.

The broader lesson for anyone sexually active right now is not panic; TMVII is treatable and has not been associated with systemic illness in immunocompetent people. The lesson is awareness. A rash that doesn't respond to standard treatment after two weeks is a signal worth taking to a clinician rather than managing solo with pharmacy products. And any new sexual contact is a reasonable prompt to run a comprehensive STI panel for the infections that do have at-home rapid tests, because catching co-infections early is always simpler than catching them late.

The Rash That Won't Quit Deserves a Real Answer

Minnesota's TMVII outbreak is not a reason to panic; it's a reason to pay attention. This infection is new, it's spreading in US cities, it looks like conditions people routinely self-treat and dismiss, and the wrong treatment makes it worse. A rash near the genitals or buttocks that doesn't clear within two weeks of standard topical antifungal treatment is not something to keep managing at home. It warrants clinical evaluation, and if you have had a new sexual partner recently, it warrants a full STI screen at the same time.

At-home testing won't catch TMVII, but it will give you a clear answer on everything else that matters. The 7-in-1 Complete At-Home STD Test Kit screens for HIV, syphilis, HSV-2, chlamydia, gonorrhea, hepatitis B, and hepatitis C in a single 20-minute session, test at 6 weeks post-exposure for accurate results across all infections with a 6-week window. For the most comprehensive panel available for women, the Women's 10-in-1 At-Home STD Test Kit adds HPV and trichomoniasis. And if you want to start with a single focused test, the HIV 1&2 At-Home Rapid Test Kit delivers a 99.7% accurate result in 20 minutes. Testing is the fastest way to stop the guessing game.

You can browse the full range of at-home rapid test kits at STD Test Kits.