Granuloma Inguinale (Donovanosis) Clinical Presentation

  • Author: Jerry J Fasoldt, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 5, 2011
 

History

Although the exact incubation period for granuloma inguinale is unknown, it ranges from a day to a year, with the median time being 50 days.[3]

Next

Physical

Morphology

The 4 main types of cutaneous lesions are as follows:

  • Nodular: The initial granuloma inguinale lesion is a papule or nodule that arises at the site of inoculation. The nodule is soft, often pruritic and erythematous, and eventually ulcerates. A nodule may be mistaken for a lymph node [ie, pseudobubo].
  • Ulcerovegetative (most common): These granuloma inguinale lesions develop from nodular lesions and consist of large, usually painless, expanding, suppurative ulcers. The ulcers have clean, friable bases with distinct, raised, rolled margins and have a tendency to bleed easily. The ulcers are "beefy red" and slowly expand centrifugally, eventually becoming more granulomatous with serpiginous borders. They are commonly located in the skin folds, and autoinoculation is a common feature, resulting in lesions on adjacent skin. Ulcers often become secondarily infected with other types of bacteria and emit a putrid odor.
  • Cicatricial: Dry ulcers evolve into cicatricial plaques and may be associated with lymphedema.
  • Hypertrophic or verrucous (relatively rare): This proliferative reaction, with the formation of large vegetating masses, may resemble genital warts.

Elephantiasislike swelling of the external genitalia is a frequent complication and is found most often in infected females in the late stage of granuloma inguinale.

Note the clinical penile images below.

Courtesy of Hon Pak, MD. Courtesy of Hon Pak, MD. Courtesy of Hon Pak, MD. Courtesy of Hon Pak, MD. Courtesy of Hon Pak, MD. Courtesy of Hon Pak, MD.

Distribution

  • The most common locations of granuloma inguinale lesions in men are the sulcocoronal and balanopreputial regions, as well as the anus.
  • In women, granuloma inguinale lesions occur on the labia minora, the mons veneris, the fourchette, and/or the cervix. Cervical involvement occurs in 10% of cases.
  • Children are frequently infected via contact with an adult; however, this is not necessarily the result of sexual abuse.[3]

Extragenital involvement

  • Extragenital involvement occurs in 6% of granuloma inguinale cases.
  • Autoinoculation or direct extension may lead to involvement of the lips, oral/gastrointestinal mucosa, scalp, abdomen, arms, legs, and bones.
  • Lymphadenopathy does not occur as a result of the primary infection with Klebsiella granulomatis, but, rather, it occurs from secondary bacterial infections. Pseudobuboes resemble lymph nodes, but they are just nodular lesions.
  • Disseminated lesions associated with systemic symptoms are frequently reported in endemic regions.[3] Hematogenous dissemination to the spleen, lungs, liver, bones, and the orbits may occur and occasionally results in death.
Previous
Next

Causes

Granuloma inguinale is caused by Klebsiella granulomatis, a gram-negative pleomorphic bacillus formerly known as Calymmatobacterium granulomatis.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Jerry J Fasoldt, MD  Head of Medical Department, Senior Flight Surgeon, Naval Operational Support Center

Jerry J Fasoldt, MD is a member of the following medical societies: Society of United States Naval Flight Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth Kline Satter, MD, MPH  Chairman, Department of Dermatology, Naval Medical Center San Diego

Elizabeth Kline Satter, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American Medical Women's Association

Disclosure: Nothing to disclose.

Specialty Editor Board

James J Nordlund, MD  Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine

James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Clara-Dina Cokonis, Steven M. Manders, and Kari Williamson Boucher to the development and writing of this article. We also thank Hon Pak for the use of his clinical pictures.

References

  1. Carter JS, Bowden FJ, Bastian I, Myers GM, Sriprakash KS, Kemp DJ. Phylogenetic evidence for reclassification of Calymmatobacterium granulomatis as Klebsiella granulomatis comb. nov. Int J Syst Bacteriol. Oct 1999;49 Pt 4:1695-700. [Medline].

  2. Anderson K. The Cultivation From Granuloma Inguinale of a Microorganism Having the Characteristics of donovan bodiesin the yolk sac of chick embryos. Science. Jun 18 1943;97(2529):560-561. [Medline].

  3. Velho PE, Souza EM, Belda Junior W. Donovanosis. Braz J Infect Dis. Dec 2008;12(6):521-5. [Medline].

  4. Barroso LF, Wispelwey B. Donovanosis presenting as a pelvic mass mimicking ovarian cancer. South Med J. Jan 2009;102(1):104-5. [Medline].

  5. Taneja S, Jena A, Tangri R, Sekhon R. Case report. MR appearance of cervical donovanosis mimicking carcinoma of the cervix. Br J Radiol. Jun 2008;81(966):e170-2. [Medline].

  6. [Guideline] British Association for Sexual Health and HIV (BASHH). Donovanosis (granuloma inguinale). In: Sexually transmitted infections: UK national screening and testing guidelines. National Guidelines Clearinghouse. Aug 2006.

  7. Sulfamethoxazole and trimethoprim [package insert]. Irvine, Calif: Sicor Pharmaceuticals; 2003.

  8. Bowden FJ, Savage J. Azithromycin for the treatment of donovanosis. Sex Transm Infect. Feb 1998;74(1):78-9. [Medline].

  9. Rosen T, Vandergriff T, Harting M. Antibiotic use in sexually transmissible diseases. Dermatol Clin. Jan 2009;27(1):49-61. [Medline].

  10. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep. May 10 2002;51:1-78. [Medline].

  11. Kallen BA, Otterblad Olausson P, Danielsson BR. Is erythromycin therapy teratogenic in humans?. Reprod Toxicol. Jul-Aug 2005;20(2):209-14. [Medline].

  12. Manders SM, Baxter JD. Granuloma inguinale and HIV: a unique presentation and novel treatment regimen. J Am Acad Dermatol. Sep 1997;37(3 Pt 1):494-6. [Medline].

  13. [Guideline] Centers for Disease Control and Prevention. Diseases characterized by genital ulcers. Sexually transmitted diseases treatment guidelines 2006. MMWR Morb Mortal Wkly Rep. Aug 4 2006;55(RR-11):14-30.

  14. Bowden FJ. Donovanosis in Australia: going, going... Sex Transm Infect. Oct 2005;81(5):365-6. [Medline].

  15. Sardana K, Garg VK, Arora P, Khurana N. Malignant transformation of donovanosis (granuloma inguinale) in a HIV-positive patient. Dermatol Online J. 2008;14(9):8. [Medline].

  16. Chandra Gupta TS, Rayudu T, Murthy SV. Donovanosis with auto-amputation of penis in a HIV-2 infected person. Indian J Dermatol Venereol Leprol. Sep-Oct 2008;74(5):490-2. [Medline].

  17. Sardana K, Garg VK, Arora P, Khurana N. Malignant transformation of donovanosis (granuloma inguinale) in a HIV-positive patient. Dermatol Online J. Sep 15 2008;14(9):8. [Medline].

 
Previous
Next
 
Beefy-red penile ulcers.
Courtesy of Hon Pak, MD.
Courtesy of Hon Pak, MD.
Courtesy of Hon Pak, MD.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.