STI

The global outbreak of Mpox in 2022 fundamentally shifted our understanding of how emerging infectious diseases can utilize intimate skin-to-skin and sexual networks to rapidly propagate. However, Mpox was only the vanguard. Recent clinical shifts through 2025 and 2026 have revealed an expanding spectrum of atypical, emerging dermatological pathogens presenting as sexually or closely transmitted infections (STIs).

This presentation explores the epidemiology, clinical presentation, and diagnostic nuances of three highly unusual pathogens currently surfacing in sexual health networks, particularly among gay, bisexual, and other men who have sex with men (GBMSM):

Genotype VII of Trichophyton mentagrophytes (TMVII): A highly inflammatory, sexually transmitted ringworm originating in Southeast Asia that causes deep, painful pustules and is frequently misdiagnosed as a bacterial infection.

• Dermatophilus congolensis: Classically a zoonotic bacterial pathogen (“rain rot” in livestock) that has recently driven unprecedented human-to-human cluster outbreaks within commercial adult saunas and intimate settings.
• Klebsiella (e.g., K. aerogenes) Folliculitis: An enteric, Gram-negative bacterium causing persistent, treatment-refractory beard and genital folliculitis, often linked to oro-anal contact and shared humid spaces.

Learning Objectives

By the end of this presentation, participants will be able to:

• Identify Atypical Presentations: Distinguish the clinical characteristics of emerging cutaneous STIs (T. mentagrophytes TMVII, Dermatophilus, and Klebsiella folliculitis) from common mimics like classic acne, staphylococcal folliculitis, and traditional jock itch.
• Analyze Transmission Dynamics: Evaluate how microenvironments (e.g., adult saunas, hot tubs) and specific sexual networks amplify the human-to-human transmission of historically environmental or zoonotic pathogens.
• Formulate Diagnostic Strategies: Implement appropriate microbiological and mycological sampling techniques—including fungal cultures, molecular testing, and deep-pustule swabs—to avoid the empirical misuse of ineffective antibiotics or topical steroids.
• Apply Outbreak Lessons: Utilize public health strategies learned from the Mpox response to deliver non-stigmatizing, targeted risk communication and community-led interventions during emerging dermatological outbreaks.
• Optimize Therapeutic Management: Design correct, targeted treatment regimens for these emerging pathogens, recognizing that conditions like TMVII require systemic oral antifungals rather than topical creams.