Rare Livestock Skin Disease Found in Gay Men in Europe
Doctors in France and Spain are investigating clusters of dermatophilosis spreading among men who have sex with men.
Researchers in France and Spain have diagnosed several men who have sex with men in at least three countries with dermatophilosis, a skin disease that typically infects livestock, reports STAT News.
The clusters of infections are reminiscent of the early stages of the 2022 mpox outbreak, with the disease spreading through networks of men who have sex with men.
Dermatophilosis is caused by the bacterium Dermatophilus congolensis. The infection — also known as “rain rot,” “rain scald,” “lumpy wool disease,” and streptotrichosis — typically affects cattle, sheep, goats, and horses, primarily in tropical and subtropical climates.
In rare cases where the bacteria affects humans, infections have generally occurred among people who have direct contact with infected animals, such as farmers, hunters, veterinarians, or riders. The disease, which is usually mild — although it can occasionally become more severe — presents as a rash consisting of pimples, pustules, or crusty lesions that do not itch.
Lesions typically occur on parts of the body that are chronically wet or prone to cuts and abrasions, including the back, face, ears, and legs. Wet skin and open cuts or abrasions are especially vulnerable to infection. Previously, there were no documented cases of human-to-human transmission.
In articles published in the Centers for Disease Control and Prevention’s Emerging Infectious Diseases journal, doctors reported two primary clusters of dermatophilosis infections in Barcelona, Spain, and Lyon, France.
The Lyon cluster involved nine individuals, one of whom reported having multiple sexual partners at saunas in Paris. Bacterial samples from eight cases underwent genetic sequencing and were found to be similar — suggesting the bacteria can be transmitted through human sexual contact.
Since publication of the article, the number of infected individuals in the Lyon cluster has risen to 25, with cases also reported in Paris, Bordeaux, Saint-Étienne, and Annecy. One of the men had recently visited Turkey, while another traveled to Italy, where he had a sexual encounter despite having no symptoms at the time.
Matthieu Degreze, the lead author of the study on the Lyon cluster and a junior scientist at the University Hospital of Lyon, told STAT News that the two men who traveled abroad may have been infected during their trips.
Since the publication of the article on the Barcelona cluster, only one additional infection has been confirmed. However, Vicente Descalzo, the lead author of the paper on the Spanish cluster and an internal medicine specialist in the STI/HIV unit at Barcelona’s Drassanes-Hospital Vall d’Hebron, told STAT News that other Barcelona-area physicians have reported seeing a case or two. Additionally, after the CDC articles were published, a doctor in Berlin contacted him about similar cases there.
It remains unclear whether the bacteria responsible for both clusters share a similar genetic sequence.
In both clusters, the pimples or pustules mostly appeared on areas of the body exposed during sexual contact, although it remains unclear whether asymptomatic people can transmit the disease through human contact.
Additionally, none of those infected were immunocompromised. All cases were relatively mild and either cleared up on their own or were successfully treated with antibiotics. The bacterium appears to be susceptible to multiple antibiotics.
None of the infected men reported exposure to infected animals. However, because nearly all of them reported attending saunas before developing symptoms, some researchers believe saunas may play a role in transmission. Dermatophilus congolensis is known to spread more efficiently in humid environments.
While he believes the condition may be underdiagnosed, Descalzo said most doctors would likely prescribe antibiotics, which would eliminate the infection and reduce the risk of transmission — provided infected individuals abstain from sexual contact until the rash clears up.
Demetre Daskalakis, the former director of the CDC’s Division of HIV Prevention who now serves as chief medical officer at New York City’s Callen-Lorde Community Health Center, said dermatophilosis appears similar to a relatively benign form of folliculitis, a condition in which hair follicles become inflamed and small pimples form.
Daskalakis noted there is concern about how dermatophilosis might present in immunocompromised people, such as those with uncontrolled HIV.
The World Health Organization told STAT News that it is aware of the cases in Europe but currently considers the risk of dermatophilosis infections rising to epidemic levels to be low. However, the agency said the cases highlight the importance of making clinicians in sexual health care settings aware of emerging infections and ensuring appropriate testing to determine the cause of unexplained skin lesions.
Daskalakis said owners of saunas frequented by men who have sex with men, along with patrons, should practice good hygiene to help curb potential transmission.
“It’s a good time for these saunas to make sure that they’re doing a lot of cleaning,” he said. “But I think it also speaks to men who are attending these venues. You can try to say, ‘Don’t attend the venues,’ but it’s not going to work. We know that historically. I think it’s [about] making sure that they’re doing all the stuff that they need for hygiene and making sure they shower after encounters, etc.”
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