Granuloma lnguinale (Donovanosis)

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Rare in Zambia

This is a chronic granulomatous condition usually involving the genitalia and spreads by sexual contact. It is common in the tropical and subtropical climate and is caused by gram-negative, Calymmatobacterium granulomatis and intracellular bacillus found in mononuclear cells.

Clinical FeaturesThe initial lesion is a painless, beefy-red nodule. Multiple nodules appear and coalesce to form a large elevated, velvety, granulomatous mass. The incubation period is 1 to 12 weeks. The sites of infection in men are penis, scrotum, groin and thighs, whereas in women the vulva, vagina and perineum are the common sites, with the face being affected in both sexes. In homosexual men, the anus and buttocks are affected. There is no lymphadenopathy. The infection may involve other parts of the body. Progress is slow but the eventual lesion may cover the whole external genitalia, the deep-seated ulcers causing lymphatic obstruction and elephantiasis of the genitalia. Healing is also slow and often leads to scar tissue formation. Secondary infection is common and can cause gross tissue destruction.

Complications

• Anaemia
• Weight loss

DiagnosisDo a punch biopsy of the lesion and crush between two glass slides. Stain with Wright's or Giemsa Stain to show gram-negative rods within macrophages. Secondly, send the biopsy for histopathology to rule out squamous cell carcinoma. Thirdly, diagnosis can be based on clinical findings that are often characteristic i.e. bright, beefy- red granulomatous lesions.

Treatment Drugs
• Erythromycin 500mg orally 6 hourly for 14 to 21 days.

Prevention: • Condom use is advisable