(See also Overview of Sexually Transmitted Infections Overview of Sexually Transmitted Infections Sexually transmitted infections (STIs), also termed sexually transmitted diseases or STDs, can be caused by a number of microorganisms that vary widely in size, life cycle, the diseases and... read more .)
Infections with K. granulomatis are extremely rare but have been previously reported in areas such as Papua New Guinea, Australia, southern Africa, the Caribbean, and parts of Brazil and India.
Symptoms and Signs of Granuloma Inguinale
Sites of infection are
Penis, scrotum, groin, and thighs in men
Vulva, vagina, and perineum in women
Anus and buttocks in patients who engage in anal-receptive intercourse
Face in both sexes
After an incubation period of about 1 to 12 weeks, a painless, red skin nodule slowly enlarges, becoming a raised, beefy red, moist, smooth, foul-smelling lesion. The lesion slowly enlarges, often ulcerates, and may spread to other skin areas. Lesions heal slowly, with scarring. Secondary infections with other bacteria are common and can cause extensive tissue destruction. Lymphadenopathy is uncommon.
Occasionally, granuloma inguinale spreads through the bloodstream to the bones, joints, or liver; without treatment, anemia, wasting, and, uncommonly, death may occur.
This photo shows genital granuloma inguinale.
Image courtesy of Joe Miller and Dr. Cornelio Arevalo via the Public Health Image Library of the Centers for Disease Control and Prevention.
This photo shows genital granuloma inguinale.
Image courtesy of Dr. Susan Lindsley via the Public Health Image Library of the Centers for Disease Control and Prevention.
This photo shows perianal granuloma inguinale.
Image courtesy of Dr. Tabua via the Public Health Image Library of the Centers for Disease Control and Prevention.
Granuloma inguinale is a progressive ulcerative disease that is usually sexually transmitted and involves the skin and subcutaneous tissues in the anogenital and inguinal regions. The initial nodule slowly enlarges, erodes the surrounding tissues, and develops into a beefy, bulky, granulomatous mass.
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Diagnosis of Granuloma Inguinale
Microscopic examination showing Donovan bodies in fluid from a lesion
Granuloma inguinale is suspected in patients from endemic areas with characteristic lesions.
Diagnosis of granuloma inguinale is confirmed microscopically by the presence of Donovan bodies (numerous bacilli in the cytoplasm of macrophages shown by Giemsa or Wright stain) in smears of fluid from scrapings from the edge of lesions. These smears contain many plasma cells.
Biopsy specimens are taken if the diagnosis is unclear or if adequate tissue fluid cannot be obtained because lesions are dry, sclerotic, or necrotic. The bacteria do not grow on ordinary culture media.
Treatment of Granuloma Inguinale
Antibiotics (various)
Many oral antibiotics kill the bacteria, but tetracyclines, macrolides, and trimethoprim/sulfamethoxazole (TMP/SMX) are most effective, followed by ceftriaxone, aminoglycosides, fluoroquinolones, and chloramphenicol.
Recommended oral regimens include
Doxycycline 100 mg twice a day for 3 weeks
TMP/SMX 160/800 mg twice a day for 3 weeks
Erythromycin 500 mg four times a day for 3 weeks
Azithromycin 1 g a week for 3 weeks
IV or IM antibiotics (eg, ceftriaxone) are an alternative.
Response to treatment should begin within 7 days, but healing of extensive disease may be slow and lesions may recur, requiring longer treatment. HIV-infected patients may also require prolonged or intensive treatment. After apparently successful treatment, follow-up should continue for 6 months.
Current sex partners should be examined and, if infected, treated.
