- Clinical science
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.
- Pathogen: : Klebsiella granulomatis (gram-negative, aerobic, encapsulated)
Route of transmission
- Sexual transmission
- Autoinoculation of adjacent skin
- Perinatal transmission
- Men who have sex with men
- Uncircumcised men
- Low socioeconomic status
- Incubation period: highly variable (1 day to 1 year); median time ∼ 50 days
- Painless genital lesion: begin as one or more nodules; eventually ulcerate to form large, beefy-red lesions that bleed easily
- ♂: foreskin, coronal sulcus, glans
- ♀: labia minora, cervix
- Rarely presents in the oral cavity or pharynx
- Regional lymph nodes typically spared
Granuloma inguinale is a clinical diagnosis supported by the presence of Donovan bodies in smears from the lesion.
Confirmatory test: demonstration of Donovan bodies in biopsies and/or smears from lesions
- Intracytoplasmic cysts filled with deeply staining , safety-pin shaped bodies within macrophages (Pud cells)
- PCR: if Donovan bodies or not present and to differentiate K. granulomatis from other Klebsiella species
- K. granulomatis cannot be cultured.
- See the .
The differential diagnoses listed here are not exhaustive.
- Genital pseudoelephantiasis (seen especially in women)
- Bacterial superinfection of the ulcer
- Neoplastic transformation of the ulcer
- Osteomyelitis (rare)
We list the most important complications. The selection is not exhaustive.