Donovanosis is a mildly contagious, chronic, indolent, progressive, autoinoculable, ulcerative disease involving the skin and lymphatics of the genital and perianal areas.
Causes of Donovanosis
Poorly understood. Mildly contagious. Repeated exposure necessary for clinical infection to occur. In most cases, lesions cannot be detected in sexual contacts.
Men are affected more than twice as often as women, with most infections occurring in people aged 20-40 years. 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 infected men and women have lesions in the anal area.
Symptoms of Donovanosis
Small, painless nodules appear after about 10–40 days of the contact with the bacteria. Later the nodules burst, creating open, fleshy, oozing lesions. The infection spreads, mutilating the infected tissue. The infection will continue to destroy the tissue until treated. The lesions occur at the region of contact typically found on the shaft of the penis, the labia, or the perianal region. Rarely, the vaginal wall or cervix is the site of the lesion.
Diagnosis
Clinical diagnosis excluding other causes of genital ulcer(s) and identifying organism with touch preparation or crush preparation of biopsied tissue.
Treatment
Antimicrobial therapy
- Recommended regimens Treatment appears to halt progressive destruction of tissue, although prolonged duration of therapy often is required to enable granulation and re-epithelialization of ulcers.
- Trimethoprim-sulfamethoxazole One double-strength tablet bid for at least 3 weeks
- Doxycycline 100 mg bid for at least 3 weeks
Alternative regimens
- Sulfamethoxazole 750 mg bid for at least 3 weeks
- Erythromycin base 500 mg qid for at least 3 weeks
Parenteral therapy If lesions do not respond within the first few days of therapy, the addition of an aminoglycoside (gentamicin, 1 mg/kg IV q8h) should be considered.
Follow-up Patients should be followed clinically until signs and symptoms have resolved.
Prevention
- Safe sex practices will prevent the spread of granuloma inguinale, as well as other sexually-transmitted diseases.
- Monitoring the patient’s ulcers or scar tissue for signs of reinfection for a period of six months after antibiotic treatment
- Sexual contact with people living in tropical and subtropical climates increases the likelihood of exposure.
References