Clusters of dermatophilosis in five EU/EEA countries in 2025–2026

Several clusters of genetically and epidemiologically linked cases predominantly affecting gay, bisexual and other men who have sex with men have been detected in four EU countries during the past six months. Cases have also been reported in Norway among individuals practicing martial arts, in 2025 and 2026. This indicates a possible shift in transmission dynamics, with human-to-human transmission through close physical contact being the most likely route. Indirect transmission via contaminated surfaces and fomites cannot be excluded at this stage. 

This rapid risk assessment was produced to assess the current situation as D. congolensis infection is an unusual occurrence in humans. The target audience is public health authorities, community organisations and healthcare workers.

Four EU countries (France, Germany, Spain, Sweden) have reported 70 cases of skin infections caused by D. congolensis, predominantly among gay, bisexual and other men who have sex with men who visited sex-in-premises venues (including adult spas) where close physical contact, including sexual contact, may have occurred. These venues can be defined as commercial establishments where men can socialise and engage in consensual sexual activity with other men if they choose to do so. Most cases were diagnosed between December 2025 and June 2026. The clinical spectrum included papular, pustular or scaly, pruritic skin lesions, mainly in the genital and facial area, without systemic symptoms. All cases responded well to oral or topical antibiotics, with occasional self-limiting resolution. One EEA country (Norway) reported ten additional cases occurred linked to martial arts activities, with exposure taking place either in Norway (summer 2025) or during travel to Thailand (January 2026). In Austria, D. congolensis was identified in ten individuals in 2025 and seven by mid-2026 (mostly in men), based on data from two Vienna laboratories.

The overall risk of this event for the general population is assessed as very low, considering the very low probability of infection with D. congolensis and the very low impact due to the mild clinical course of the disease. 

Among gay, bisexual and other men who have sex with men who have multiple sexual partners, the overall risk is assessed as low, given the low probability of infection – which reflects current evidence of human-to-human transmission, mainly through direct skin contact during sexual activity – and very low impact due to the mild clinical course of the disease. 

The probability increases in gay, bisexual and other men who have sex with men who have multiple sexual partners and attend sex-in-premises venues. In this group, the probability of infection rises to moderate due to the current epidemiological evidence of exposure in these venues. Given the very low impact due to the mild clinical course of the disease, the overall risk is still low.

• Countries should continue epidemiological and microbiological investigations to better characterise transmission routes, risk factors and the extent of spread, and are encouraged to share results via EpiPulse.
• Perform whole genome sequencing (WGS) of all cases and environmental isolates to increase understanding of transmission routes and identify the original source. ECDC can provide support for WGS for countries without in-country capacity.
• Raise awareness among clinicians and laboratories to support timely recognition, testing, early access to treatment and reporting of cases.
• Implement targeted risk communication and prevention advice for gay, bisexual and other men who have sex with men, including messaging on dermatophilosis.
• The upcoming Pride season provides a strong communication opportunity.
• Collaborate with community-based organisations to reach these populations effectively and without generating stigma.
• Owners and operators of sex-in-premises venues should reinforce hygiene measures.