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