What You Need to Know About Granuloma Inguinale

Written by Christine DiMaria | Published on August 7, 2012
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

What Is Granuloma Inguinale?

Granuloma inguinale is a sexually transmitted infection (STI). It is a rare disease that does not usually occur in the United States.

This STI causes lesions in the anal and genital regions. These lesions often recur, even after treatment.

Granuloma inguinale is sometimes called “donovanosis.”

What Causes Granuloma Inguinale?

A class of bacteria known as Klebsiella granulomatis causes this infection. Granuloma inguinale is a sexually transmitted infection, and you can contract it by having vaginal or anal intercourse with an infected partner. In rare instances, it can be contracted through oral sex.

The Symptoms and Stages of Granuloma Inguinale

Signs of the condition have a slow onset. It usually takes at least one week to experience symptoms; however, it can take up to 12 weeks for symptoms to reach their peak. Generally, you will first experience a pimple or a lump on your skin. This blemish is small and not typically painful, so you may not notice it at first. In 90 percent of cases, the infection begins in the genital region. Anal or mouth sores occur only in a minority of instances and only if the sexual contact involved these areas.

The skin lesion progresses through three stages:

Stage One

In the first stage, the small pimple will begin to spread and eat away at the surrounding tissue. As the tissue begins to wear away, it turns pink or a faint red. The bumps then turn into raised red nodules with a velvety texture. This happens around the anus and genitals. Although the bumps are painless, they can bleed if they are injured.

Stage Two

In the second stage of the disease, bacteria begin to erode the skin. Once this occurs, you will develop shallow ulcers that will spread from the genitals and anus to the thighs and lower abdomen (inguinal area). You will notice that the perimeters of the ulcers are lined with granulated tissue. A foul smell may accompany the ulcers.

Stage Three

When granuloma inguinale advances to the third stage, the ulcers become deep and morph into scar tissue.

How Is Granuloma Inguinale Diagnosed?

Granuloma inguinale can be difficult to detect in the early stages, since you may not notice the initial lesions. Your doctor will usually not suspect granuloma inguinale unless ulcers have begun to form and do not clear up.

If the ulcers do not heal after a prolonged period of time, your physician may order a skin biopsy of the lesions. This will probably be performed as a punch biopsy. When you undergo a punch biopsy, your doctor will remove a small area of the ulcer with a circular blade. Once removed, the sample will be tested for the presence of Klebsiella granulomatis bacteria. It may also be possible to detect bacteria by scraping some of the lesion and conducting further tests on the sample.

Since having granuloma inguinale is know to raise your risk for other sexually transmitted diseases (STDs), you may be given blood tests or have other diagnostic testing or cultures taken to check for those as well.

Who Is at Risk for Granuloma Inguinale?

You put yourself at risk if you have sexual contact with individuals from the tropical and subtropical regions where the disease is most prevalent. most. Males are twice as likely to acquire granuloma inguinale as women. As a result, homosexual men have a greater likelihood of getting granuloma inguinale. Individuals who are between the ages of 20 and 40 contract the condition more often than those in other age groups.

Where you live plays a role in determining your risk of infection. For instance, if you live in the United States and are infected, it is usually because you had sexual contact with someone who lives abroad. According to Medscape Reference, about 100 cases of granuloma inguinale occur in the United States each year, and the southeastern part of the country seems to be the most affected (Fasoldt, et al., 2011).

According to the National Institutes of Health, tropical and subtropical climates are the most likely areas where people encounter granuloma inguinale. The disease is endemic in New Guinea, Guyana, Southeast India, and some parts of Australia. A higher number of cases are also reported in parts of Brazil and South Africa.

Treatment for Granuloma Inguinale

Granuloma inguinale can be treated using antibiotics like tetracycline and the macrolide erythromycin. Streptomycin and ampicillin may also be used. Most treatments are prescribed for three weeks, although they will continue until the infection is cured. Early treatment is advised to prevent the occurrence of permanent scarring and swelling in the genital, anal and inguinal areas.

After you have been treated, you need to have routine examinations to ensure that the infection does not come back. In some cases, it recurs after it seems to have been cured.

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