II. Epidemiology
- Rarest of the sexually transmited diseases that cause Genital Ulcers
III. Pathophysiology
- Caused by Klebsiella granulomatis (previously known as Calmmatobacterium Granulomatis)
IV. Signs
- Lymphadenopathy absent (contrast with Lymphogranuloma venereum and Chancroid)
- Subcutaneous vascular Granulomas may be palpable
- Scars on healing
-
Papule or Genital Ulcer
- Persistent, painful, beefy-Red Papules or ulcers onset 2-3 months after exposure
- Necrosis or sclerosis may occur
- Mutilates surrounding tissue
V. Labs
- Screen for other Sexually Transmitted Infections (esp. HIV Infection)
VI. Diagnosis: Histology
- Grows poorly in culture (biopsy instead)
- Tissue samples
- Roll cotton swab over ulcer bed and then over slide
- Ulcer edge sample (Punch Biopsy, curettage)
- Stains
- Wright stain
- Giemsa stain
- Biopsy findings suggestive of Granuloma Inguinale
- Intracytoplasmic Donovan Bodies
- Bipolar staining with safety pin appearance
- Calymmatobacterium granulomatis organisms
- Rod shaped, encapsulated within Macrophages
- Intracytoplasmic Donovan Bodies
VII. Management
- Evaluate all sexual partners within prior 60 days
- Continue antibiotics until lesions are fully healed (at least 21 days)
- Antibiotics (Minimum course: 21 days)
- Azithromycin 1 gram orally once weekly
- Ciprofloxacin 750 mg orally twice daily
- Erythromycin Base 500 mg orally four times daily
- Doxycycline 100 mg orally twice daily (higher risk of treatment failure)
- Trimethoprim-Sulfamethoxazole (Bactrim) DS 160/800 orally twice daily (higher risk of treatment failure)
- Refractory cases
- Gentamicin 1 mg/kg IV every 8 hours
VIII. Complications
-
Lymphatic obstruction
- Risk of elephantiasis
- Relapse
- May occur at 6-18 months despite successful initial antibiotic treatment
IX. References
- (2018) Sanford Guide, accessed on IOS 10/26/2019
- (2015) MMWR Morb Mortal Wkly Rep 64(RR3):1-37 [PubMed]
- Velho (2008) Braz J Infect Dis. Dec 12(6):521-5 [PubMed]
- Roett (2012) Am Fam Physician 85(3): 254-62 [PubMed]