Granuloma Inguinale (Donovanosis): Symptoms, Causes, Treatment

What are the symptoms of granuloma inguinale?

Granuloma inguinale, also known as donovanosis, is a rare sexually transmitted infection caused by the bacterium Klebsiella granulomatis. It primarily affects the genital and perianal regions and is more common in tropical and subtropical regions. The symptoms of granuloma inguinale typically develop within 1 to 12 weeks after exposure to the bacterium and may include:

1. Painless genital ulcers: The initial symptom is usually the appearance of small, painless, raised, red or pink ulcers on the genitals or around the anus. These ulcers may gradually increase in size and can be beefy red in appearance.
2. Granulomatous lesions: As the infection progresses, the ulcers can develop into raised, beefy red, granulomatous lesions that bleed easily when touched.
3. Foul-smelling discharge: In some cases, the lesions may produce a foul-smelling discharge.
4. Inguinal lymphadenopathy: Swelling of the lymph nodes in the groin area (inguinal lymphadenopathy) may occur in some cases.
5. Genital deformities: In rare cases, chronic, untreated granuloma inguinale can lead to genital deformities due to tissue destruction.

It’s important to note that granuloma inguinale can be easily mistaken for other genital ulcers caused by sexually transmitted infections, such as syphilis, herpes, or chancroid. Therefore, it’s crucial to seek medical attention for proper diagnosis and treatment if you experience any symptoms of genital ulcers or lesions.

What are the causes of granuloma inguinale?

Granuloma inguinale is caused by infection with the bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). The bacterium is primarily transmitted through sexual contact, including vaginal, anal, or oral sex with an infected partner. It can also be transmitted from mother to child during childbirth.

Risk factors for granuloma inguinale include:

1. Sexual activity: Having unprotected sexual intercourse, especially with multiple partners or in areas where the infection is more common, increases the risk of contracting granuloma inguinale.
2. Living in or traveling to endemic regions: Granuloma inguinale is more common in tropical and subtropical regions, such as parts of Africa, Southeast Asia, India, and Papua New Guinea. Traveling to or living in these regions can increase the risk of exposure to the bacterium.
3. HIV infection: People infected with HIV are at an increased risk of developing granuloma inguinale, as the infection can weaken the immune system and make it more difficult to fight off bacterial infections.
4. Other sexually transmitted infections: Having other sexually transmitted infections, such as syphilis, herpes, or chancroid, can increase the risk of contracting granuloma inguinale.

It’s important to note that granuloma inguinale is relatively rare in developed countries and is more commonly seen in areas with poor sanitation and limited access to healthcare. Early diagnosis and treatment are essential to prevent complications and reduce the risk of transmission to others.

How is the diagnosis of granuloma inguinale made?

The diagnosis of granuloma inguinale is usually based on a combination of clinical symptoms, physical examination findings, and laboratory tests.

1. Clinical examination: A healthcare provider will examine the genital and perianal areas for the presence of characteristic lesions, which are typically painless, raised, beefy red ulcers or nodules. The appearance of these lesions, along with the patient’s sexual history and risk factors, can help suggest a diagnosis of granuloma inguinale.
2. Microscopic examination: A sample of tissue or fluid from the ulcer or lesion may be collected and examined under a microscope to look for the presence of Klebsiella granulomatis bacteria. This is usually done using a staining technique called Wright-Giemsa stain or by using special stains for bacterial identification.
3. PCR testing: Polymerase chain reaction (PCR) testing may be used to detect the genetic material of Klebsiella granulomatis in samples from the ulcer or lesion. PCR testing is highly sensitive and specific and can help confirm the diagnosis of granuloma inguinale.
4. Biopsy: In some cases, a biopsy of the affected tissue may be performed to obtain a larger sample for examination. A biopsy can help confirm the presence of granulomatous inflammation and rule out other conditions that can cause similar symptoms.
5. Serologic tests: Blood tests may be done to detect antibodies to Klebsiella granulomatis, although these tests are not widely available and are not routinely used for diagnosis.

It’s important to note that the diagnosis of granuloma inguinale can be challenging, as the symptoms can resemble those of other sexually transmitted infections, such as syphilis, herpes, or chancroid. Therefore, it’s crucial to seek medical attention for proper diagnosis and treatment if you suspect you may have granuloma inguinale or any other genital ulcer disease.

What is the treatment for granuloma inguinale?

Granuloma inguinale is typically treated with antibiotics to eliminate the bacterial infection. The choice of antibiotics depends on the severity of the infection and the patient’s overall health. Commonly used antibiotics for the treatment of granuloma inguinale include:

1. Azithromycin: This is often used as the first-line treatment for uncomplicated cases of granuloma inguinale. A single dose of 1 gram or 500 mg once daily for at least 3 weeks is usually effective.
2. Doxycycline: This antibiotic is an alternative to azithromycin and is taken twice daily for at least 3 weeks.
3. Ciprofloxacin: In cases where azithromycin and doxycycline are not suitable, ciprofloxacin may be used. It is taken twice daily for at least 3 weeks.
4. Other antibiotics: In some cases, other antibiotics such as erythromycin, trimethoprim-sulfamethoxazole, or tetracycline may be used, especially if the infection is severe or if there are complications.

Treatment with antibiotics usually leads to the resolution of symptoms and the healing of lesions. However, it’s important to complete the full course of antibiotics as prescribed by a healthcare provider, even if symptoms improve before the course is completed. Failure to complete the full course of antibiotics can lead to recurrence of the infection or development of antibiotic resistance.

In addition to antibiotic treatment, regular follow-up visits with a healthcare provider are important to monitor the response to treatment and ensure that the infection has been fully cleared. It’s also important for sexual partners to be tested and treated if necessary to prevent the spread of the infection.