Granuloma Inguinale (Donovanosis)
In the United States granuloma inguinale is a rarely encountered sexually-transmitted disease that results in surface destruction and granuloma formation in the skin and subcutaneous tissue.
Description A sexually transmitted disease generally affecting people living in tropical climates. It is becoming more common in the U.S., especially in the south and southwest regions. Incubation period is 8 to 12 weeks. Frequent Signs and Symptoms
Granuloma inguinale is a bacterial disease caused by the organism Calymmatobacterium granulomatis. The disease is commonly found (endemic) in the tropical and subtropical areas of the world (such as Southeast India, Guyana, and New Guinea), but it occurs on occasion in the United States (typically in the Southeast). There are approximately 100 cases reported per year in the United States.
Men are more often affected than women, with a ratio of 2.5 to 1. Peak incidence occurs between 20 and 40 years old. The disease is seldom seen in children or the elderly. It is thought that anal intercourse, rather than vaginal intercourse, is the most frequent source of infection. About 50% of the infected men and women have lesions in the anal area also. Formation of a nonpainful lesion (cyst, papule, or nodule) in the genital area that does not readily heal. This lesion ulcerates (becomes open and runny) and may spread so that it involves most of the vulva, and sometimes the but-tocks and lower abdomen. Marked discomfort occurs if the ulceration spreads to the urethra or anal area. Walking, sitting and sexual intercourse become painful. Vaginal discharge that has an unpleasant odor.
Causes An organism, Calymmatobacterium granulomatis (Donovan body), that is spread via sexual intercourse with an infected person. Risk Increases With Multiple sexual partners. Unprotected intercourse. Infection with other sexually transmitted diseases. Preventive Measures Monogamous sexual relationship. Having the male partner use a latex condom. Cleansing of the genital area before and after sex. Douching is usually not effective. If there has been good possibility of exposure, seek medical care immediately. Early treatment may head off the infection.
Expected Outcome With treatment, healing should begin within a week, but complete resolution will take up to 3 weeks. Possible Complications Secondary bacterial infection. Relapse may occur if treatment is stopped too soon. Scars may form where infection occurred. Treatment/Post Procedure Care
General Measures Diagnosis is confirmed with laboratory studies of scrapings or biopsies of the lesions. Testing (screening) for other sexually transmitted diseases is often recommended. Treatment is with medication. Sitz baths frequently relieve soreness. Sit in a tub of hot water for 10 to 15 minutes. Repeat baths as often as 3 or 4 times a day. Sexual partners should be examined for infection. A follow-up medical examination after treatment is important to verify that healing is complete. Additional information is available from the Sexually Transmitted Diseases Hotline, (800) 227-8922. Medication
An antibiotic, such as tetracycline, will be prescribed. Do not discontinue medicine until healing is complete or when advised to by the doctor. Activity
Avoid sexual intercourse during the active phase of the infection. Diet
No special diet. If taking tetracycline, avoid dairy products within 3 hours of taking the medicine.