Summary about Disease
Calymmatobacterium granulomatis infection, also known as granuloma inguinale or donovanosis, is a chronic, progressive, ulcerative disease of the genital, perianal, and inguinal regions. It is a sexually transmitted infection (STI) caused by the bacterium Klebsiella granulomatis (formerly *Calymmatobacterium granulomatis*). While relatively rare, it can cause significant tissue destruction if left untreated.
Symptoms
The primary symptom is the appearance of small, painless nodules or bumps on the genitals, perineum (area between the genitals and anus), or inner thighs. These nodules eventually ulcerate (break down), forming beefy red, velvety, and often painless sores. The ulcers bleed easily upon contact. Spread to other areas of the body is rare but possible. Pseudo-buboes (swollen, but not infected, lymph nodes) may also occur.
Causes
The infection is caused by the bacterium Klebsiella granulomatis. Transmission usually occurs through sexual contact (vaginal, anal, or oral). While the bacterium is present in lesions, the exact mechanism of transmission is not fully understood, and repeated exposure may be necessary for infection to occur in some individuals. Non-sexual transmission is very rare.
Medicine Used
Antibiotics are the primary treatment. Common medications include:
Azithromycin: Often the first-line treatment due to its ease of administration (oral).
Doxycycline: Another commonly used antibiotic.
Ciprofloxacin: An alternative, but resistance can be a concern.
Erythromycin: Can be used if other antibiotics are contraindicated (e.g., during pregnancy).
Trimethoprim-sulfamethoxazole (TMP-SMX): Another alternative. Prolonged treatment courses (weeks to months) are usually necessary.
Is Communicable
Yes, it is communicable, primarily through sexual contact. However, it is considered less contagious than some other STIs.
Precautions
Abstinence: Avoiding sexual contact is the most effective way to prevent transmission.
Condom Use: Consistent and correct use of condoms can reduce the risk of transmission, but it doesn't eliminate it entirely due to the potential for lesions to be present on areas not covered by the condom.
Early Diagnosis and Treatment: Prompt diagnosis and treatment are crucial to prevent the spread of the infection and to minimize tissue damage.
Partner Notification: Informing sexual partners so they can get tested and treated is essential.
Avoid Sharing Personal Items: Though rare, avoid sharing personal items that might come into contact with open sores.
Good Hygiene: While not a primary preventative measure, maintaining good hygiene in the genital area may help.
How long does an outbreak last?
Without treatment, granuloma inguinale can persist for months or even years. The lesions can slowly enlarge and cause extensive tissue destruction. With appropriate antibiotic treatment, improvement is usually seen within the first few weeks, but complete healing may take several months.
How is it diagnosed?
Diagnosis is typically made by:
Clinical Examination: Visual inspection of the lesions.
Microscopy: A tissue sample (biopsy or scraping) from the ulcer is stained (e.g., with Wright-Giemsa stain) and examined under a microscope. The presence of Donovan bodies (bacteria within histiocytes) is characteristic of the disease.
Polymerase Chain Reaction (PCR): A PCR test to detect Klebsiella granulomatis DNA can be performed on tissue samples.
Histopathology: Microscopic examination of a tissue biopsy.
Exclusion of Other STIs: Ruling out other STIs that can cause similar symptoms (e.g., syphilis, chancroid, herpes).
Timeline of Symptoms
Incubation Period: The incubation period is variable, ranging from a few days to several months (typically 1 to 12 weeks).
Initial Lesion: A small, painless papule or nodule appears on the genitals, perineum, or inner thighs.
Ulceration: The nodule breaks down, forming a painless, beefy red ulcer.
Progression: The ulcer slowly enlarges and can spread to other areas.
Complications (Untreated): Without treatment, the ulcers can lead to significant tissue destruction, scarring, and secondary infections. Pseudo-elephantiasis (swelling) of the genitals can also occur.
Important Considerations
HIV Co-infection: Individuals with HIV may have more severe and refractory infections.
Pregnancy: Granuloma inguinale during pregnancy can lead to complications for both the mother and the baby. Erythromycin is often used in pregnant women, but consultation with an infectious disease specialist is important.
Differential Diagnosis: It is important to differentiate granuloma inguinale from other genital ulcer diseases.
Compliance with Treatment: Adherence to the prescribed antibiotic regimen is crucial for successful treatment. Prolonged treatment courses are often necessary.
Scarring: Even with treatment, scarring may occur, especially with extensive lesions.
Rare Complications: Extragenital spread (e.g., to the bones, liver, or lungs) is rare but possible.