STD

Granuloma Inguinale

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Granuloma Inguinale, Calymmatobacterium granulomatis, Klebsiella granulomatis, Donovanosis, Donovan Body, Donovan Bodies

  • Epidemiology
  1. Rarest of the ulcerative sexually transmited diseases
  • Signs
  1. Lymphadenopathy absent (contrast with Lymphogranuloma venereum and Chancroid)
  2. Subcutaneous vascular granulomas may be palpable
    1. Scars on healing
  3. Papule or 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
  • 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
  • Management
  1. Continue antibiotics until lesions are fully healed (at least 21 days)
  2. Antibiotics (Minimum course: 21 days)
    1. Doxycycline 100 mg orally twice daily
    2. Azithromycin 1 gram orally once weekly
    3. Ciprofloxacin 750 mg orally twice daily
    4. Erythromycin base 500 mg orally four times daily
    5. Trimethoprim-Sulfamethoxazole (Bactrim) DS 160/800 orally twice daily
  • Complications
  1. Lymphatic obstruction
    1. Risk of elephantiasis