Granuloma inguinale is a bacterial disease caused by Klebsiella granulomatis characterized by genital ulcers. It is endemic in many less-developed regions. It is also known as donovanosis, granuloma genitoinguinale, granuloma inguinale tropicum, granuloma venereum, granuloma venereum genitoinguinale, lupoid form of groin ulceration, serpiginous ulceration of the groin, ulcerating granuloma of the pudendum, and ulcerating sclerosing granuloma. The disease often goes untreated because of the scarcity of medical treatment in the countries in which it is found. In addition, the painless genital ulcers can be mistaken for syphilis. The ulcers ultimately progress to destruction of internal and external tissue, with extensive leakage of mucus and blood from the highly vascular lesions. The destructive nature of donovanosis also increases the risk of superinfection by other pathogenic microbes.
Symptoms
Small, painless nodules appear after about 10–40 days of the contact with the bacteria. Later, the nodules burst, creating open, fleshy, oozing lesions. The infection spreads, mutilating the infected tissue. The infection will continue to destroy the tissue until treated. The lesions occur at the region of contact typically found on the shaft of the penis, the labia, or the perineum. Rarely, the vaginal wall or cervix is the site of the lesion. At least one case in India led to partial autoamputation of the penis. The patient tested positive for HIV-2 and had been infected for six years.
Mechanism
The microorganism spreads from one host to another through contact with the open sores.
The first known name for this condition was "serpiginous ulcer", which dates to 1882. The proper clinical designation for donovanosis is "granuloma inguinale". A granuloma is a nodular type of inflammatory reaction, and inguinale refers to the inguinal region, which is commonly involved in this infection. The disease is commonly known as donovanosis, after the Donovan bodies seen on microscopy, which are a diagnostic sign. The causative organism, Klebsiella granulomatis, was called Calymmatobacterium granulomatis, and some sources still use this classification, from the Greek kalymma, referring to the lesions that contain the bacteria. Prior to this, it was called Donovania granulomatis, named after the Donovan bodies. The specific namegranulomatis refers to the granulomatous lesions. The organism was recently reclassified under the genusKlebsiella, a drastic taxonomic change since it involved changing the organism's phylum. However, polymerase chain reaction techniques using a colorimetric detection system showed a 99% similarity with other species in the genus Klebsiella.
Prevention
The disease is effectively treated with antibiotics, therefore, developed countries have a very low incidence of donovanosis; about 100 cases reported each year in the United States. However, sexual contacts with individuals in endemic regions dramatically increases the risk of contracting the disease. Using condoms, sexually transmitted disease testing before beginning a sexual relationship, and avoidance of these sexual contacts are effective preventative measures for donovanosis.
Treatment
Recommended regimen is azithromycin 1gram oral/iv once per week, alternatively doxycycline 100 mg orally twice a day or ciprofloxacin 750 mg orally twice a day or erythromycin base 500 mg orally four times a day or trimethoprim-sulfamethoxazole one double-strength tablet orally twice a day. All antibiotic regimens should last for at least 3 weeks and until all lesions have completely healed. Normally, the infection will begin to subside within a week of treatment, but the full treatment period must be followed to minimize the possibility of relapse. According to the CDC 2015 guidelines Azithromycin is the antibiotic of choice.
