Granuloma inguinale

McLeod 1882.

Donovanosis, granuloma venereum.

Sexual disease caused by the intracellular Calymmatobacterium granulomatis (Donovania granulomatis, Klebsiella granulomatis).

• Occurring mainly in tropical and subtropical areas
• Males > females

The causative agent is Klebsiella granulomatis, formerly called Calymmatobacterium granulomatosis or Donovania granulomatosis.

• In the inguinal region, genital and anal areas, indolent pustules, papules or subcutaneous nodules appear after about 2 weeks (incubation period 1-10 weeks) after infection. In the course of the disease, confluence or ulceration of the primary florescences may occur. It is not uncommon for abscess formation to occur
• Lymphoedema may develop
• In women, the infection is often asymptomatic.

• Anamnesis
• Clinical picture
• Biopsy/curettage
• Nucleic acid amplification techniques are performed in specialised laboratories
• Laboratory
  • Exclusion of co-infections
  • HIV serology
  • Hepatitis B, C serology
  • Syphilis serology

Pathogen intracellular in macrophages. In Giemsa staining or silvering, bipolar coccoid intracytoplasmic inclusion bodies (Donovan bodies) can be visualised from clusters of pathogens.

Untreated, peripheral extension occurs in 10% of cases and can assume monstrous proportions. Obstruction of the lymphatic vessels can lead to elephantiasis of the penis, scrotum and labia

• Spontaneous healing is rare
• During the course, a spinocellular carcinoma may develop

Partner co-treatment!

Surgical removal of the exophytic skin lesions.

Topical therapy

• Antiseptics
• Iodine-povidone wound ointment, solution, ointment gauze

Systemic therapy

• Azithromycin p.o. 1g/week for a period of 3 weeks
• Trimethoprim-sulfamethoxazole 960mg (equivalent to 160mg/800mg) p.o. 2 times daily for 3 weeks
• Doxycycline p.o. 100 mg 2 times a day for 21 days
• Ciprofloxacin p.o. 500mg 2x tgl. for 21 days

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4. Braun-Falco`s Dermatologie, Venerologie und Allergologie, 7. Auflage