Granuloma inguinale

Published on 18/03/2015 by admin

Filed under Dermatology

Last modified 22/04/2025

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 1649 times

Granuloma inguinale

Jacqueline A. Guidry and Ted Rosen

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

image

Granuloma inguinale, or donovanosis, is an infection causing granulomatous and destructive ulceration of genital, inguinal, and perineal skin. This disorder is extremely rare in Western Europe and the US, but is still endemic or epidemic in India, South Africa, Brazil, Papau New Guinea, and among aborigines in Australia. The causative organism is Klebsiella granulomatis, an intracellular Gram-negative bacillus.

Transmission is frequently, but not exclusively, sexual. The disease presents with a subcutaneous granuloma or nodule that develops into characteristically painless, progressive ulcerative lesions without regional lymphadenopathy. Most often lesions are ulcerogranulomatous, highly vascular (i.e., a beefy red appearance) and friable (bleed easily on contact). Some lesions can be sub-categorized as hypertrophic, necrotic, or sclerotic.

Management strategy

Patients with donovanosis should be treated to prevent the gradual development of the disease leading to genital deformity or (very rarely) life-threatening disseminated infection, to prevent transmission, and to prevent the risk of concomitant transmission of HIV.

In the absence of evidence from randomized placebo-controlled trials, antibiotic treatment of donovanosis is based on the results of local clinical experience and individual case reports, typically involving relatively small numbers of patients.

The US Centers for Disease Control and Prevention (CDC) (2010) recommends doxycycline, with many alternate regimens (e.g., azithromycin, ciprofloxacin, erythromycin, trimethoprim–sulfamethoxazole). Azithromycin is also recommended in the European Guideline on donovanosis (2010). The addition of an aminoglycoside, such as gentamicin, is recommended by the CDC if lesions do not respond within the first few days.

Therapy should be continued until all lesions have healed completely. This typically starts at the outside margins and progresses inward. Despite seemingly effective initial therapy, a relapse can occur six to 18 months later. Surgical excision may be necessary for extensive disease unresponsive to antibiotic therapy.

Sexual partners of patients who have granuloma inguinale should be examined and treated if they had sexual contact with the patient during the 60 days preceding the onset of symptoms in the patient, or have clinical signs and symptoms of the disease.

Specific investigations

First-line therapies

imageAzithromycin B
imageDoxycycline C

Third-line therapies

imageCeftriaxone C
imageGentamicin C
imageSurgical treatment E
imageNorfloxacin C
imageTrovofloxacin C
imageAmpicillin C
imageChloramphenicol C
imageThiamphenicol C

Share this:

Related posts:

Xanthomas Radiation dermatitis Scleredema Erythromelalgia Cryptococcosis Panniculitis