Granuloma Inguinale

Repetitive exposure may be required for the infection to develop. Symptoms may not appear immediately after the exposure and it could take up to twelve weeks for the symptoms to occur after exposure to the bacteria.

Symptoms and features of the infection include small red papules or nodules on the genitals or around the anal area and sores or ulceration in the genital area. The infection may spread to the inguinal folds and may cause damage to the genital tissue, and the skin gradually wears away [6]. Color loss in the infected area may also be noticed.

The diagnosis depends on the clinical features and appearance of the lesions on the genital area of the patient [7]. If the condition is suspected based on the clinical findings, a smear is taken from the edge of the lesions and examined microscopically to confirm the diagnosis of granuloma inguinale. If the smear shows Donovan bodies (multiple bacilli in macrophages cytoplasm shown by Write or Giemsa stain), the daignosis of granuloma inguinale is confirmed.

If the lesions are dry or the diagnosis was unclear, a biopsy specimen may be taken and examined to confirm the diagnosis. Ordinary bacterial cultures do not help in the diagnosis of granuloma inguinale because the bacateria Klebsiella granulomatis do not grow on these culture media.

Granuloma inguinale is a bacterial infection and treatment with antibiotics is required to resolve the infection and the related signs and symptoms. Different antibiotics may be used in the treatment of the infection. However, the most commonly used ones are either trimethoprim/sulfamethoxazole or doxycycline. Other antibiotics include azithromycin, erythromycin, or ciprofloxacin [8]. The course of the antibiotics should not be less than three weeks and should last until the signs and symptoms of the condition have resolved and the reepitheliaization of the ulcers occurs. Tetracycline was used for the treatment of the infection. However, it is not used anymore in some countries because of the bacterial resistance to tetracycline [9].

An aminoglycoside should be added if there was no response after a few days of initiation of the antibiotics treatment. Tissue and skin damage in the genital area may not heal with medical treatment, and surgical repair may be required to correct the tissue damage. Even with successful treatment, relapses of granuloma inguinale are possible, and may occur any time up to 18 months after successful treatment.

The prognosis of granuloma inguinale depends on the treatment, and the lesions may continue to expand causing genital tissue damage if left untreated. Relapses of the infection are possible and may develop up to 18 months after successful treatment of the condition.

Granuloma inguinale is a sexually transmitted disease, which means it could be transmitted through vaginal, anal or even oral sex in rare cases. The infection is caused by the gram negative bacteria Klebsiella granulomatis [1].

Granuloma inguinale is a very rare infection (less than 100 cases are reported annually), and the number of cases have been decreasing recently due to good preventive measures. Patients who get infected with granuloma inguinale are usually in endemic or tropical areas, such as India, the Caribbean, South Africa, Australia, Western New Guinea, and Papua [4] [5]. Granuloma inguinale is rarely reported in the United States.

The incidence of the infection differs between races. Like for example, in Western New Guinea the incidence among the native population is higher than the incidence in Europeans. This difference in incidence between races is most likely due to the difference in the socioeconomic status.

Granuloma inguinale is transmitted sexually. However, the risk of transmission is very low and repetitive exposure is required in order for the infection to be transmitted from a partner to another. Granuloma inguinale may also be transmitted through the fecal route, or from the mother to her baby through the birth canal.

Granuloma inguinale is a rare infection and only a few cases are reported annually. The number of reported cases is even decreasing more and more because of the good preventive measures that have been taken for several years.

A committee was established, in Australia and other areas were the infection was reported, under the name of (National Donovanosis Eradication Advisory Committee). The main goal of this committee is to decrease the incidence and the risk of the infection by developing educational materials, services, and protocols for the treatment, management and prevention of granuloma inguinale. This committee was very successful in the control and prevention of granuloma inguinale, and since the establishment of the committee, there is a substantial decrease in the incidence of infection [10].

Granuloma inguinale is a genital infection, which usually causes painless ulceration of the genitals. Granuloma inguinale is a bacterial infection caused by the gram negative bacteria Klebsiella granulomatis (formerly called Calymmatobacterium granulomatis) [1] [2]. The bacteria responsible for the infection was initially classified as Calymmatobacterium granulomatis in 1913. However, it was reclassified as Klebsiella granulomatis because it was found that its molecular structure was similar to the molecular structure of the Klebsiella species [1] [3].

Granuloma inguinale is found in different areas of the world. However, it is most commonly found in poor tropical areas, such as India, South Africa, and some areas in Australia. The condition presents with ulcerative lesions on the genital tract, which may spread and cause damage to the genital tissue and skin. Treatment of granuloma inguinale may include different antibiotics. However, trimethoprim/sulfamethoxazole or doxycycline are the most commonly used antibiotics in the treatment of the infection.

Granuloma inguinale is a rare sexually transmitted bacterial infection caused by Klebsiella granulomatis. The infection is manifested by genital ulceration and lesions, which may spread wider and cause damage to the genital tissue and skin.

The symptoms of granuloma inguinale may not appear immediately after exposure to the bacteria. It could take several weeks for the symptoms to appear and they include painless ulceration and lesions around the genital area.

The doctor will make the diagnosis of granuloma inguinale based on the clinical appearance and features of the infection, which are noticed around the genital area. A smear may be taken from the lesions and examined microscopically to confirm the diagnosis. In rare cases, when the diagnosis is hard to make, a biopsy specimen could be taken from the lesions and examined.

Granuloma inguinale is a bacterial infection, and once diagnosed, treatment with antibiotics should start immediately and last for at least three weeks and until the signs and symptoms of the infection resolve. Different antibiotics may be used in the treatment, however, trimethoprim/sulfamethoxazole and doxycycline are the ones most commonly used.

After successful treatment with antibiotics, surgical repair may be needed to repair the damaged tissue and skin.

Good treatment with antibiotics plays an important role in the outcome of the condition. If left untreated, the genital lesions could expand and spread to the inguinal folds and cause damage to the surrounding tissue and skin. Relapse of the infection is possible and could develop up to 18 months after treatment.

Due to good preventive measures, including protocols for management, and educational materials in endemic areas, the incidence of the condition has decreased significantly in the last few years. Education about the condition and sexually transmitted infections is very important in raising awareness and decreasing the risk of getting infected.

1. Carter JS, Bowden FJ, Bastian I, et al. Phylogenetic evidence for reclassification of Calymmatobacterium granulomatis as Klebsiella granulomatis comb nov. Int J Syst Bacteriol. 1999; 49: 1695–700.
2. Kharsany AB, Hoosen AA, Kiepala P, et al. Phylogenetic analysis of Calymmatobacterium granulomatis based on 16S sequences. J Med Microbiol. 1999; 48: 841–7.
3. Anderson K. The Cultivation From Granuloma Inguinale of a Microorganism Having the Characteristics of donovan bodiesin the yolk sac of chick embryos. Science. June 18, 1943; 97(2529): 560-561.
4. Bowden FJ. National Donovanosis Eradication Advisory Committee. Donovanosis in Australia: going, going. Sex Transm Infect. 2005; 81: 365–6. 
5. O'Farrell N. Donovanosis. Sex Transm Infect. 2002; 78: 452–7.
6. Govender D, Naidoo K, Chetty R. Granuloma inguinale (donovanosis): an unusual cause of otitis media and mastoiditis in children. Am J Clin Pathol. November 1997; 108(5): 510-4.
7. O’Farrell N, Hoosen AA, Coetzee KD, et al. Genital ulcer disease: accuracy of clinical diagnosis and strategies to improve control in Durban, South Africa. Genitourin Med. 1994; 70: 7–11.
8. Bowden FJ, Savage J. Azithromycin for the treatment of donovanosis. Sex Transm Infect. February 1998; 74(1): 78-9.
9. Rosen T, Vandergriff T, Harting M. Antibiotic use in sexually transmissible diseases. Dermatol Clin. January 2009; 27(1): 49-61.
10. Bowden FJ. Donovanosis in Australia: going, going... Sex Transm Infect. October 2005; 81(5): 365-6.