What is Granuloma Inguinale (Donovanosis?)
Donovanosis is a sexually transmitted infection caused by the gram negative bacteria Klebsiella granulomatis. It is more common in places like Southern Africa, parts of Southern America and India.
Clinical Presentation of Granuloma Inguinale
Patients often present with beefy red granulomatous painless genital ulcers which tend to bleed easily. The local lymph nodes will not be involved. The ulcers may also be super-infected with other bacterial infections or other sexually transmitted diseases.
Diagnostic tests of Granuloma Inguinale
1.Biopsy of the genital ulcers will show Donovan bodies and granulomas.
2.Tissue smears taken from the genital ulcers will show intra-cellular Donovan bodies with “safety-pin” alike bipolar staining found within the histiocytes.
Treatment of Granuloma Inguinale
The ulcers can be cleaned with anti-septic solution or normal saline. Patients should be treated with oral antibiotics. The recommended antibiotics are:
1.Oral doxycycline 100 mg twice daily for 3 days OR
2.Oral azithromycin 1gram once weekly for 4-6 weeks OR
3.Oral azithromycin 500mg once daily for 1 week
If patients cannot tolerate the above antibiotics, other options include:
1.Oral ciprofloxacin 750mg twice daily for 3 weeks OR
2.Oral Co-trimoxazole 160/800mg 2 tablets twice daily for 3 weeks OR
3.Oral erythromycin 500 mg 4 times daily for 3 weeks OR
4.Intra-muscular Gentamicin 1mg per kg 3 times daily if above agents does no work.
Co-trimoxazole, ciprofloxacin and doxycycline is contraindicated in pregnant women.
If treatment with antibiotics works, patient should see clinical response within 1 week. The treatment is continued until the ulcers heal completely. Relapse does occur and it can occur anytime 6 to 18 months post-therapy.
Sexual partners who have sex with patient within 60 days from onset of the symptoms should see a doctor and offer therapeutic treatment.