Sexually Transmitted Infections: Granuloma Inguinale (Donovanosis)

Introduction

• Description: Granuloma inguinale (also called Donovanosis) is relatively common in the tropics, India, Papua New Guinea, South Africa, and Caribbean areas but accounts for fewer than 100 cases per year in the United States. This infection is caused by the intracellular gram-negative bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis ).

• Prevalence: Uncommon; 100 cases per year in the United States; up to 25% of the population in some subtropical areas.

• Predominant Age: Younger reproductive age.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Infection is caused by the bipolar, gram-negative bacterium K. granulomatis.

• Risk Factors: Sexual trauma and exposure to the infective agent.

Signs and Symptoms

• Single or multiple painless subcutaneous papules that evolve to raised, beefy-red, granulomatous lesions that bleed on contact, undergo ulceration and necrosis, and heal slowly (lesions are confined to the genitalia in 80% of patients and generally appear within 2 weeks of exposure).

• Painless papules with rolled borders and friable base

• Marked adenopathy not present

• Hypertrophic, necrotic, or sclerotic variants exist

Diagnostic Approach