II. Epidemiology

  1. Rarest of the sexually transmited diseases that cause Genital Ulcers

III. Pathophysiology

  1. Caused by Klebsiella granulomatis (previously known as Calmmatobacterium Granulomatis)

IV. Signs

  1. Lymphadenopathy absent (contrast with Lymphogranuloma venereum and Chancroid)
  2. Subcutaneous vascular Granulomas may be palpable
    1. Scars on healing
  3. Papule or Genital Ulcer
    1. Persistent, painful, beefy-Red Papules or ulcers onset 2-3 months after exposure
    2. Necrosis or sclerosis may occur
    3. Mutilates surrounding tissue

V. Labs

VI. Diagnosis: Histology

  1. Grows poorly in culture (biopsy instead)
  2. Tissue samples
    1. Roll cotton swab over ulcer bed and then over slide
    2. Ulcer edge sample (Punch Biopsy, curettage)
  3. Stains
    1. Wright stain
    2. Giemsa stain
  4. Biopsy findings suggestive of Granuloma Inguinale
    1. Intracytoplasmic Donovan Bodies
      1. Bipolar staining with safety pin appearance
    2. Calymmatobacterium granulomatis organisms
      1. Rod shaped, encapsulated within Macrophages

VII. Management

  1. Evaluate all sexual partners within prior 60 days
  2. Continue antibiotics until lesions are fully healed (at least 21 days)
  3. Antibiotics (Minimum course: 21 days)
    1. Azithromycin 1 gram orally once weekly
    2. Ciprofloxacin 750 mg orally twice daily
    3. Erythromycin Base 500 mg orally four times daily
    4. Doxycycline 100 mg orally twice daily (higher risk of treatment failure)
    5. Trimethoprim-Sulfamethoxazole (Bactrim) DS 160/800 orally twice daily (higher risk of treatment failure)
  4. Refractory cases
    1. Gentamicin 1 mg/kg IV every 8 hours

VIII. Complications

  1. Lymphatic obstruction
    1. Risk of elephantiasis
  2. Relapse
    1. May occur at 6-18 months despite successful initial antibiotic treatment

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