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Granuloma Inguinale

What is granuloma inguinale?

Granuloma inguinale is a sexually transmitted infection (STI) caused by the bacteria Calymmatobacterium or Klebsiella granulomatis. It is rare in New Zealand. It is characterised by lesions on the genitals or perianal area that start as raised nodules (granulomas) and then erode to form beefy-red velvety heaped-up ulcers that gradually increase in size.

Granuloma inguinale is also called Donovanosis. Donovan bodies are cellular components that are seen when scrapings from the eg of the lesions are viewed under a microscope.

Who is at risk of granuloma inguinale?

Sexually active people may be at risk of getting granuloma inguinale. It is most commonly found in tropical or subtropical areas of the world such as Papua New Guinea, central Australia, Southern India, the Caribbean and Guyana. In countries where it is less frequently seen, cases are most probably related to foreign travel.

It possibly occurs more frequently in men than women and the peak incidence is in persons between 20–40 years old.

What are the signs and symptoms of granuloma inguinale?

After contracting the infection it may take from 1 week to 3 months for any signs and symptoms to appear. There are several types of lesions that may occur and symptoms are mild.

  • The nodular type consists of soft lumps that are typically beefy red in colour and tend to bleed easily. These are usually painless despite ulceration.
  • The hypertrophic or verrucous type consists of large dry warty masses that resemble genital warts.
  • The necrotic type presents as dry ulcers that evolve into scarred areas .

Complications such as bleeding, secondary infection and swelling (lymphoedema) may occur. Local lymph nodes may be enlarged and may become abscesses or ulcers as the infection spreads into the overlying skin.

In the early stages it may be difficult to differentiate granuloma inguinale from chancroid. In the later stages, the condition may look like lymphogranuloma venereum. It may also be confused with other conditions, such as penile or vulvar cancer or syphilis.

How is the diagnosis of granuloma inguinale made?

The main method of diagnosis is the demonstration of Donovan bodies in a tissue sample taken by crush preparation or biopsy. Other tests such as culturepolymerase chain reaction (PCR) or serology are not routinely available.

What is the treatment for granuloma inguinale?

Granuloma inguinale is treated with antibiotics. Treatment with antibiotics should be for at least 3 weeks and then continued until the lesions have completely healed.

  • Trimethoprim-sulfamethoxazole and doxycycline are the antibiotics of choice.
  • Alternatives include erythromycin, ciprofloxacin and azithromycin.
  • If there are no signs of healing within the first few days of treatment with initial antibiotic therapy, the addition of intravenous gentamicin may be necessary.

Sexual activity should not take place until all lesions are completely healed. Follow-up examination is necessary to ensure a complete recovery.

If granuloma inguinale is left untreated or treatment is delayed it may cause widespread destruction of the genitals and leave permanent swelling and scarring. Infection may also spread to other parts of the body and cause secondary problems such as pneumonia or heart failure.

Can granuloma inguinale be prevented?

All sexual activity should be refrained from until the lesions have completely healed. As with other sexually transmitted infections, if you think you are infected, stop all sexual contact and see your doctor or sexual health clinic immediately. Safe-sex practices will prevent the spread of granuloma inguinale as well as other sexually transmitted diseases.

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