Granuloma Inguinale (Donovanosis) Follow-up

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

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]
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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]
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Prognosis

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

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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.

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].

 
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Beefy-red penile ulcers.
Courtesy of Hon Pak, MD.
Courtesy of Hon Pak, MD.
Courtesy of Hon Pak, MD.
 
 
 
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