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DonovanosisA58.x0

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 26.12.2021

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Synonym(s)

Granuloma pudendum chronicum; Granuloma pudendum tropicum; inguinal granuloma; serpiginous ulcer of the genitalia; Ulcerating granuloma of the pudenda; venereal granuloma

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HistoryThis section has been translated automatically.

McLeod, 1882

DefinitionThis section has been translated automatically.

Low-contagious, sexually transmitted, chronic granulomatous infectious disease of the genital and perigenital region, endemic in tropical and subtropical areas.

PathogenThis section has been translated automatically.

The causative agent is Klebsiella granulomatosis, formerly known as Calymmatobacterium granulomatis or Donovania granulomatis, an encapsulated gram-negative rod (see below Klebsiella). Taxonomically, the pathogen is assigned to the Klebsiellae. It lives intracellularly (leukocytes, histiocytes; plasma cells). Culture is possible (yolk sac), but is considered difficult. Transmission through sexual intercourse.

Occurrence/EpidemiologyThis section has been translated automatically.

Endemic to India, the Caribbean, Brazil, the west coast of Africa, the South Pacific Islands. Sporadically also in Europe, North America.

ManifestationThis section has been translated automatically.

Almost exclusively in sexually active men from 20 to 40 LJ. Women as latent germ carriers.

LocalizationThis section has been translated automatically.

Mainly in the inguinal, but also genital and anal regions.

Clinical featuresThis section has been translated automatically.

After an incubation period of 1-12 weeks, development of non-painful, itchy pustules, papules or nodules. In the further course, increasing confluence and ulcerous decay, formation of soft, slightly bleeding, hypertrophic granulations with velvety, light red, later also yellowish smeary surface. Continuous spread of the painless, beet-like vegetations towards the groins. If not treated, abscess formation often occurs. Lymph node swellings (bubones) are atypical. Rarely, the development of lymphedema of the penis, scrotum or labia is possible due to obstruction of the lymphatic channels, especially as a result of secondary infections. In MSM, anal infestation is possible.

DiagnosisThis section has been translated automatically.

Pathogen detection from tissue material ( biopsy, curettage). The Giemsa staining reveals so-called Donovan bodies (large mononuclear cells with intracellular bacteria). Exclusion of co-infections.

Differential diagnosisThis section has been translated automatically.

Condylomata lata; pemphigus vegetans; genital herpes; lymphogranuloma inguinale.

External therapyThis section has been translated automatically.

Disinfecting envelopes with quinosol solution (e.g. quinosol 1:1000) or R042, diluted potassium permanganate solution(light pink) or polyvidon iodine solution. Surgical removal of vegetative beds.

Notice!

Control and if necessary co-treatment of the sexual partner!

Internal therapyThis section has been translated automatically.

Cotrimoxazole (e.g. Cotrimox-Wolff) 4 times/day 500 mg p.o. for 2-4 weeks until the lesion is completely healed. Alternatively: Tetracycline (e.g. Tetracycline Heyl 500) 4 times/day 500 mg p.o. or Doxycycline (e.g. Doxycycline Stada 100) 2 times/day 100 mg p.o. Alternatively: Azithromycin (Zithromax) 1 time / week 1 g p.o. for at least 3 weeks.

In pregnancy: Erythromycin (e.g. Erythromycin 500 Heumann) 4 times/day 500 mg p.o. or i.v. for 3 weeks.

Progression/forecastThis section has been translated automatically.

Development of spinocellular carcinoma possible after decades. Without treatment chronic course, no spontaneous healing possible. With timely antibiotic therapy scarred healing.

LiteratureThis section has been translated automatically.

  1. Arora AK et al (2017) Donovanosis and squamous cell carcinoma: The relationship conundrum! Int J STD AIDS 28:411-414.
  2. Belda Jr W (2020). Donovanosis. An Bras Dermatol 95:675-683.
  3. Kleine W (1984) Granuloma venereum. Z Hautkr 60: 100-102
  4. McLeod K (1882) Precis of operations performed in the wards of the first surgeon, Medical College Hospital (Rio), during the year 1881. Indian Medical Gazette 17: 113.
  5. Morrone A et al (2003) Donovanosis in developed countries: neglected or misdiagnosed disease? Int J STD AIDS 14: 288-289
  6. Petzoldt D, Gross G (2001) Diagnosis and therapy of sexually transmitted diseases. Guidelines of the German STD Society. Springer Berlin Heidelberg
  7. Sehgal VN et al (1984) A clinical profile of donovanosis in a non-endemic area. Dermatologica 168: 273-278
  8. O'Farrell N (2001) Donovanosis: an update. Int J STD AIDS 12: 423-427
  9. Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep 51(RR-6): 1-78

Authors

Last updated on: 26.12.2021

Author: Prof. Dr. med. Peter Altmeyer