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donovanosis (granuloma inguinale, granuloma venereum)
Chronic, progressively destructive bacterial infection of the genital region.
Etiology:
- Calymmatobacterium granulomatis
- Klebsiella granulomatis
Epidemiology:
1) most common in young males
2) sexual as well as non-sexual transmission
3) mildly contagious; repeated exposure necessary for clinical infection
4) endemic in tropical & subtropical areas
-> India, Caribbean, Africa, Australia (aborigines)
5) rare in USA, Candada & Europe
Pathology:
1) epitheliomatous hyperplasia
2) ulceration
3) incubation period 8-80 days
4) lesions spread by autoinoculation or direct extension
5) histopathology:
a) Donovan bodies in cytoplasm of macrophages (pathognomonic)
b) extensive acanthosis
c) dense dermal infiltrate of plasma cells & histiocytes
Clinical manifestations:
1) genital lesions
a) papule or subcutaneous nodule that ulcers within a few days
b) beefy-red granulation tissue with sharply-defined edges
c) relatively painless
2) distribution
a) males: prepuce or glans penis, penile shaft, scrotum
b) females: labia minora, mons veneris, fourchette
c) lesions spread to inguinal & perianal skin
d) extragenital lesions:
-> mouth, lips, throat, face, GI tract, bone
3) variants
a) ulcerovegetative lesions
b) nodular
d) hypertrophic
e) cicatricial
Laboratory:
1) punch biopsy
2) serology for syphilis
Complications:
-> squamous cell carcinoma
Differential diagnosis:
1) genital ulcers
a) syphilis
b) chancroid
c) lymphogranuloma venereum
d) cutaneous tuberculosis
e) cutaneous amebiasis
f) filariasis
g) squamous cell carcinoma
2) perianal hypertrophic donovanosis
a) condyloma accuminata
b) condylomata lata
Management:
1) little tendency towards spontaneous healing
2) lesions may heal with depigmentation after antibiotic treatment
3) pharmaceutical agents
a) chloramphenicol* 500 mg PO every 8 hours
b) gentamicin* 1 mg/kg IV every 12 hours
c) tetracycline* 500 mg PO QID for 3-4 weeks (until ulcers have healed)
d) streptomycin 1 g IM BID
e) ampicillin 500 mg PO QID for up to 12 weeks
f) Bactrim DS PO BID for 10 days
4) sexual partners should be evaluated & treated
* treatments of choice
General
bacterial infection
skin infection
granulomatous disease
References
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 894-95