eMedicine Specialties > Dermatology > Bacterial Infections

Granuloma Inguinale (Donovanosis): Follow-up

Author: Jerry J Fasoldt, MD, Head of Medical Department, Senior Flight Surgeon, Naval Operational Support Center
Coauthor(s): Elizabeth Kline Satter, MD, MPH, Chairman, Department of Dermatology, Naval Medical Center San Diego
Contributor Information and Disclosures

Updated: Feb 5, 2010

Follow-up

Deterrence/Prevention

  • Positive strides have been made in reducing the incidence of granuloma inguinale in endemic regions.
    • Australia and its surrounding indigenous areas have witnessed a decrease in the incidence of granuloma inguinale through the establishment of a National Donovanosis Eradication Advisory Committee. The committee consists of project officers representing different geographic areas who work closely with primary care healthcare providers.
    • The goal is to develop educational materials, conduct in-service teaching for staff in rural and remote areas, implement common protocols for treatment and diagnosis, and undertake active surveillance. Since the development of the committee in 2001, the number of new cases of granuloma inguinale has fallen to the lowest levels since the commencement of accurate epidemiological data collection.
    • This committee represents a proven model of public health intervention, using centralized officers with expertise in sexually transmitted infection who liaise with primary healthcare providers. A similar model may help reduce the incidence of disease in other endemic areas.14

Complications

  • The most serious complication of granuloma inguinale is carcinoma, which is reported to occur in 0.25% of patients. This includes squamous cell carcinoma and basal cell carcinoma. Of note, squamous cell carcinoma is sometimes difficult to histologically distinguish from pseudoepitheliomatous hyperplasia associated with the lesions of granuloma inguinale. Furthermore, it is possible for granuloma inguinale and squamous cell carcinoma to coexist in the same lesion.15
  • Once the lesions have healed, extensive fibrosis, stricture formation, and phimosis, leading to significant deformity and functional disability, may occur.
  • Elephantiasis of the genitals may develop secondary to lymphatic destruction.
  • Granuloma inguinale may also progress to involve extragenital sites, with potentially fatal systemic spread to the viscera.
  • Granuloma inguinale also increases the risk of acquiring HIV, and the risk is augmented with chronic lesions. Co-infection with HIV results in persistent ulcers that require intensive prolonged treatment with antibiotics.3
  • Autoamputation of the penis has been reported in a man with long-standing granuloma inguinale associated with underlying HIV-2 infection.16

Prognosis

  • Relapse may occur up to 18 months after treatment.
  • If untreated, the lesions may continue to expand for years.

Patient Education

Miscellaneous

Special Concerns

  • Pregnancy and HIV-associated granuloma inguinale are special concerns in the treatment of this condition. The addition of a parenteral aminoglycoside (eg, gentamicin) to the treatment regimen should be considered for pregnant women and for persons with HIV-associated granuloma inguinale. See Medical Care. Additionally, note that malignant transformation and autoamputation have both been reported in HIV-positive patients with granuloma inguinale.16,17
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of Dermatology Senior Editor Thomas Shille, and 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.



More on Granuloma Inguinale (Donovanosis)

Overview: Granuloma Inguinale (Donovanosis)
Differential Diagnoses & Workup: Granuloma Inguinale (Donovanosis)
Treatment & Medication: Granuloma Inguinale (Donovanosis)
Follow-up: Granuloma Inguinale (Donovanosis)
Multimedia: Granuloma Inguinale (Donovanosis)
References
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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].

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Further Reading

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Keywords

granuloma inguinale, donovanosis, sexually transmitted disease, STD, venereal disease, VD, Donovan bodies, genital lesions,

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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.

Medical Editor

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.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

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

CME Editor

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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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