Granuloma inguinale

Background

• "Donovanosis"
• Klebsiella granulomatis: Intracellular gram negative rod
• Sexually transmitted disease
• Tropical and semitropical (India, Papua New Guinea, Australia, Carribean, Africa)

Clinical Features

• Genital/perineal ulcer
  • Chronic, painless, progressive
  • Irregular, clean-based, granulomatous, nodular
  • Hard, bleeds easily
  • "Beefy red"
• Urethral stenosis
• Lymphatic obstruction, elephantiasis
• Hematogenous spread to spleen, lungs, liver, bones, orbits

Differential Diagnosis

• Chancroid
• Herpes Simplex
• Lymphogranuloma Venereum
• Syphilis

Workup

• Microscopy: Donovan bodies
  • Short, pleomorphic rods with bipolar staining
• Screen for other STD

Management

• Doxycycline 100mg PO BID x 3 weeks or lesion heals
  • Alternative: For 3 week duration or until lesion heals
    • Azithromycin 1g PO qweek
    • Ciprofloxacin 750mg PO BID
    • Erythromycin base 500mg PO QID
    • Bactrim DS (160mg/800mg) PO BID

Sources

• Rosen's Emergency Medicine 8th edition. 2013. Chapter: Sexually Transmitted Disease p. 1318.
• Fasoldt, JJ, et al. (2013, Apr 9). Granuloma Inguinale (Donovanosis). eMedicine. Retrieved 12/24/2014 from http://emedicine.medscape.com/article/1052617-overview.