Granuloma Inguinale (Donovanosis)

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This is a disease that affects the skin and mucous membranes in the genital region; results in nodular lesions that evolve into ulcers

Causes

  • Klebsiella granulomatis

Signs and symptoms

  • Genital lesion which becomes ulcerated with offensive discharge
  • Pseudoelephantiasis of the genitalia, excruciating pain

Differential diagnosis

  • Syphilis
  • Chancroid
  • Lymphoranuloma venerum
  • Squamous cell and basal carcinoma

Complications

  • Obstructed labour
  • Squamous cell carcinoma

Investigations

  • Direct microscopy

Treatment objectives

  • Eliminate the causative organism
  • Prevent re-infection
  • Prevent complications

Non-pharmacological treatment

  • Clean ulcer and maintain good hygiene

Pharmacological treatment

Doxycycline oral

100 mg orally twice a day for at least 14 days and until all lesions have completely healed

OR

Trimethoprim-sulfamethoxazole oral

160 mg/800 mg tablet two times a day for at least 14 days and until all lesions have completely healed

Note:

Addition of another antibiotic to these regimens can be considered if improvement is not evident within the first few days of therapy:

Gentamicin IV

1 mg/kg IV every 8 hours - especially for HIV patients

Prevention

  • Counselling, compliance, condom use, and contact treatment of sexual contact(s)

Referral

  • Refer for specialist care if no improvement