• Clinical science

Granuloma inguinale (Donovanosis)

Abstract

Granuloma inguinale is a sexually transmitted bacterial disease caused by Klebsiella granulomatis. It is seen most commonly in sexually active individuals between 20 and 40 years of age. Clinically, granuloma inguinale manifests with one or more genital nodules that develop into red, painless ulcers. The regional lymph nodes are typically spared. Diagnosis of granuloma inguinale is based primarily on clinical findings and is confirmed through detection of Donovan bodies (intracytoplasmic macrophages containing bacteria) in ulcer smears or biopsies. Management focuses on antibiotic treatment with azithromycin, which is continued until the ulcers have completely healed. Surgical treatment may be necessary for patients who develop genital pseudoelephantiasis, a complication seen most commonly in women. In these cases, ulcers or scar tissue obstruct lymph drainage and lead to severe localized edema.

Epidemiology

  • Prevalence: endemic to tropical and subtropical countries
  • Incidence: < 100 cases annually in the US
  • Age range: 20–40 years
  • Sex: no known predominance

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • Pathogen: : Klebsiella granulomatis (gram-negative, aerobic, encapsulated)
  • Route of transmission
    • Sexual transmission
    • Autoinoculation of adjacent skin
    • Perinatal transmission
  • Risk factors
    • Men who have sex with men
    • Uncircumcised men
    • Low socioeconomic status

References:[2]

Clinical features

  • Incubation period: highly variable (1 day to 1 year); median time ∼ 50 days
  • Clinical features
    • Painless genital lesion: begin as one or more nodules; eventually ulcerate to form large, beefy-red lesions that bleed easily
    • Localization
      • : foreskin, coronal sulcus, glans
      • : labia minora, cervix
      • Rarely presents in the oral cavity or pharynx
    • Regional lymph nodes typically spared

Granuloma inguinale (Klebsiella granulomatis) should not be mistaken for lymphogranuloma inguinale (Chlamydia trachomatis serotype L1–L3)!


References:[3][1][2]

Diagnostics

Granuloma inguinale is a clinical diagnosis supported by the presence of Donovan bodies in smears from the lesion.

References:[4][1][5]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment


References:[4][1][5]

Complications

  • Genital pseudoelephantiasis (seen especially in women)
  • Bacterial superinfection of the ulcer
  • Neoplastic transformation of the ulcer
  • Osteomyelitis (rare)

References:[1]

We list the most important complications. The selection is not exhaustive.

  • 1. Satter EK. Granuloma Inguinale (Donovanosis). In: Granuloma Inguinale (Donovanosis). New York, NY: WebMD. http://emedicine.medscape.com/article/1052617. Updated January 23, 2017. Accessed March 25, 2017.
  • 2. Velho PENF, Souza EM de, Belda Junior W. Donovanosis. Braz J Infect Dis. 2008; 12(6). doi: 10.1590/s1413-86702008000600015.
  • 3. Kumar V, Abbas AK, Aster JC. Robbins & Cotran Pathologic Basis of Disease. Philadelphia, PA: Elsevier Saunders; 2015.
  • 4. Le T, Bhushan V, Bagga HS. First Aid for the USMLE Step 2 CK. McGraw-Hill Medical; 2009.
  • 5. O’Farrell N, Moi H. 2016 European guideline on donovanosis. Int J STD AIDS. 2016; 27(8): pp. 605–607. doi: 10.1177/0956462416633626.
last updated 09/07/2018
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