Granuloma inguinale

Background

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

Clinical Features

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

Differential Diagnosis

Sexually transmitted diseases

• Chancroid
• Chlamydia trachomatis
• Granuloma inguinale
• Hepatitis B
• Herpes Simplex Virus-2
• HIV
• Human papillomavirus
• Lymphogranuloma venereum
• Neisseria gonorrhoeae
• Trichomonas
• Syphilis

Evaluation

Workup

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

Management

• The duration of treatment is a minimum of three weeks, and should be continued until all lesions have completely healed.
• Recommended: Azithromycin 1g PO qweek
• Alternative:
  • Doxycycline 100mg PO BID
  • Ciprofloxacin 750mg PO BID
  • Erythromycin base 500mg PO QID
  • Bactrim DS (160mg/800mg) PO BID

Disposition

• Typically outpatient

See Also

• STDs
• Ulcerative STDs

External Links

https://www.cdc.gov/std/tg2015/donovanosis.htm