Donovanosis
Donovanosis, also termed as Granuloma Inguinale (GI)
is a primarily sexually transmitted bacterial disease
in which characteristic intracellular inclusions
called Donovan bodies may be seen. It usually manifests as genital
lesions, which are indolent, progressive, ulcerative, and
granulomatous.
GI is caused by Calymmatobacterium granulomatis, a
gram-negative pleomorphic bacillus. Donovanosis is mainly
transmitted through sexual intercourse, but it may also be
contracted through a fecal route or by passage through an infected
birth canal. It is considered to be only mildly contagious, and
repeated exposure may be necessary for clinical infection to occur.
The disease has become endemic in
many underdeveloped countries (Western New Guinea, the Caribbean,
Southern India, South Africa, Southeast Asia, Australia, and
Brazil). In the US there are fewer than 100 cases reported annually,
many of which are due to foreign travel. The highest incidence
occurs in persons aged 20-40 years.
Donovanosis has an incubation
period ranging from 1 week to 3 months.
SYMPTOMS AND SIGNS
The first symptoms can include
upset stomach,
diarrhea, and rectal discomfort.
The main symptom of Donovanosis is
the appearance of small, red, painless nodules on the genital area
after 10-40 days of the contact with the bacteria. Later these
nodules burst, leading to open, fleshy, oozing lesions.
These lesions can be of four
types:
1) Ulcerovegetative type (most
common): These lesions develop from the nodular type and consist of
large, usually painless, spreading, exuberant ulcers. The ulcers
have clean, friable bases with distinct, raised, rolled margins. The
ulcers are typically beefy red in appearance and bleed easily;
2) Nodular type: Soft, often
pruritic (itching), red nodules arise at the site of inoculation and
eventually ulcerate and present a bright red granulating surface;
3) Cicatricial type: Dry ulcers
evolve into cicatricial plaques;
4) Hypertrophic or verrucous type
(relatively rare): This proliferative reaction with formation of
large vegetating masses may resemble genital warts.
Then the infection spreads,
destroying the infected tissue. The lesions appear at the region of
contact typically found on the shift of the penis, the labia, or the
penile region and rarely the vaginal wall or cervix.
TREATMENT
The treatment can either be of 3 weeks with
erythromycin, streptomycin, or tetracycline, or of 12 weeks with
ampicilin. Although the infection begins to subside after a week of
treatment it is compulsory to follow the full treatment period in
order to minimize relapse.
COMPLICATIONS
Donovanosis can cause
but lymph node enlargement due to secondary bacterial
infection or pseudobuboes.
Autoinoculation or direct
extension may lead to involvement of the oral cavity and the
gastrointestinal tract.
Hematogenous dissemination to the
spleen, the lungs, the liver, the bones, and the orbits may occur
and occasionally results in death.
However, extragenital involvement
occurs in 6% of cases.
If left untreated, Donovanosis can
lead to permanent
genital scarring, destruction of the genitals, loss of skin
pigmentation around the genitals or swelling of the subcutaneous
tissue in the groin region.
PREVENTION
Donovanosis is very rare in developed countries, like
the United States (approximately 100 cases reported each year), but
the risk of contracting Donovanosis is increased by sexual contacts
with individuals in endemic regions. Preventative measures for
Donovanosis are refraining from these sexual contacts and STD
testing before beginning a sexual relationship. Also use a condom
before you engage in any type of sexual activity.
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