Granuloma inguinale

Definition

Granuloma inguinale is a sexually transmitted disease that is rarely seen in the United States.

Alternative Names

Donovanosis

Causes, incidence, and risk factors

Granuloma inguinale is caused by the bacteria Calymmatobacterium granulomatis. The disease is commonly found in tropical and subtropical areas such as Southeast India, Guyana, and New Guinea, but it occurs on occasion in the United States, typically in the Southeast. There are approximately 100 cases reported per year in the United States.

The disease spreads mostly through vaginal or anal intercourse. Very rarely, it spreads during oral sex.

Men are affected more than twice as often as women, with most infections occurring in people aged 20-40 years. The disease is seldom seen in children or the elderly.

Symptoms

Symptoms can occur between 1 to 12 weeks after coming in contact with the bacteria that causes the disease.

• About half of infected men and women have lesions in the anal area.
• Small, beefy-red bumps appear on the genitals or around the anus.
• The skin gradually wears away, and the bumps turn into raised, beefy-red, velvety nodules called granulation tissue. They are usually painless, but bleed easily if injured.
• The disease slowly spreads and destroys genital tissue.
• Tissue damage may spread to the area where the legs meet the torso. This area is called the inguinal folds.
• Genitals and surrounding skin has a loss of skin color.

In its early stages, it may be difficult to tell the difference between granuloma inguinale and chancroid.

In the later stages, granuloma inguinale may look like advanced genital cancers, lymphogranuloma venereum, and anogenital cutaneous amebiasis.

Signs and tests

Granuloma inguinale should be considered if genital lesions have been present for a long time and have been spreading.

Tests that may be done include:

• Scrapings or punch biopsy of lesion
• Culture of tissue sample (difficult to do and not routinely available)

Laboratory tests, such as those used to detect syphilis, are available only on a research basis for diagnosing granuloma inguinale.

Treatment

Antibiotics are used to treat granuloma inguinale. A complete cure requires fairly long treatment. Most treatment courses run 3 weeks or until the lesions have completely healed.

A follow-up examination is essential because the disease can reappear after an apparently successful cure.

Expectations (prognosis)

Treating this disease early decreases the chances of tissue destruction or scarring. Untreated disease results in destruction of the genital tissue.

Complications

• Genital destruction and scarring
• Loss of skin color in genital area
• Permanent genital swelling due to scarring

Calling your health care provider

Call for an appointment with your health care provider if you have had sexual contact with a person who is known to have granuloma inguinale, or if you develop symptoms similar to those listed above.

Prevention

Avoiding all sexual activity is the only absolute way to prevent a sexually transmitted disease such as granuloma inguinale. However, safer sex behaviors may reduce your risk.

The proper use of condoms, either the male or female type, greatly decreases the risk of catching a sexually transmitted disease. You need to wear the condom from the beginning to the end of each sexual activity.

References

Ballard RC. Calymmatobacterium granulomatis (Donovanosis, Granuloma Inguinale). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005:chap 233.

Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, HIV infections. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 22.

Centers for Disease Control and Prevention, Workowski KA, Berman SM. Diseases characterized by genital ulcers. Sexually transmitted diseases treatment guidelines 2006. MMWR Morb Mortal Wkly Rep. 2006 Aug 4;55(RR-11):14-30.