Donovanosis (Granuloma Inguinale)
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.
Rare in the United States (<50 cases reported annually) and other developed countries
Endemic in Australia, India, Caribbean, and Africa
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
SIGNS AND SYMPTOMS
- 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.
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
Secondary syphilis: condylomata lata
Amebiasis: necrotic ulceration
- 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