SIGNS AND SYMPTOMS Donovanosis (Granuloma Inguinale)

SIGNS AND SYMPTOMS Donovanosis

Donovanosis (Granuloma Inguinale)

 

ETIOLOGY

 

The infectious agent is Calymmatobacterium granulomatis, a gramnegative bacillus that reproduces within PMNs, plasma cells, and histiocytes, causing the infected cells to rupture 20 to 30 organisms.

Epidemiology

Rare in the United States (<50 cases reported annually) and other developed countries

Endemic in Australia, India, Caribbean, and Africa

Pathogenesis

Indurated nodule is the primary lesion.

Lesion erodes to granulomatous heaped ulcer, progresses slowly.

Pathogenic features are as follows:

Large infected mononuclear cell containing many Donovan bodies

Intracytoplasmic location

 

 

SIGNS AND SYMPTOMS

 

  1. Incubation period is 8 to 80 days.

Lesions bleed easily.

Lesions are sharply defined and painless.

Secondary infection may ensue.

Inguinal involvement causes pseudobuboes; true lymph node involve­ment is unusual.

 

 

DIAGNOSIS

 

Check for clinical manifestation

Obtain stained crushed prep from lesion. Wright stain: Donovan bodies; organisms in vacuoles within macrophages

Screen for other STDs

Exclude other causes of lesions

Differential diagnosis

Carcinoma

Secondary syphilis: condylomata lata

Amebiasis: necrotic ulceration

Concurrent infections

 

TREATMENT

 

  1. Doxycycline, 100 mg PO, bid x 3 weeks

Trimethoprim-sulfamethoxazole, 800/160 mg PO, bid x 3 weeks

Ciprofloxacin, 750 mg PO, bid x 3 weeks

Erythromycin base, 500 mg PO, tid x 3 weeks

Azythromycin, 1 g PO, qwk x 3 weeks

Continue therapy until complete healing of all lesions

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