Donovanosis

Granuloma venereum, granuloma inguinale

Sexually transmitted disease (STD), which is caused by Klebsiella granulomatis.

In some 3rd world countries (Caribbean, South America, etc.) there is endemic occurrence.

Men are more often affected than women.

Causative agent: Klebsiella granulomatis (Calymmatobacterium granulomatosis, Donovania granulomatosis), a Gram-negative facultative anaerobic rod that lives intracellularly in macrophages, where it is known as the Donovan corpuscle.

Asexual transmission has been reported in children.

Incubation period: 1 week – 3 months

A granulomatous ulcer develops from an indolent papule. The granulomatous changes inguinally can be interpreted as pseudo-lymph node swelling (pseudobubonias).

History (unprotected GV?)

Clinic

Biopsy

Nucleic acid amplification mehtodes are only performed in a few laboratories

Macrophage and plasma cell containing inflammatory infiltrate. Enlarged macrophages with intracellular bacteria (Donovan bodies) in the Giemsa stain.

Abscess formation

Elefantiasis due to obstruction of the lymphatic vessels

Topical

• Povidone iodine

Systemic

• Azithromycin p.o. 1x 1g per week or 1x 500 mg daily
• Ciprofloxacin p.o. 2x 750 mg
• Erythromycin 4x 500 mg
• Doxycycline 2x 100 mg
• Trimethoprim-sulfamethoxazole 2x 160/800 mg

All antibiotics should be given until complete healing.

Partner treatment!

1. Arora AK, Kumaran MS, Narang T, Saikia UN, Handa S. Donovanosis and squamous cell carcinoma: The relationship conundrum! Int J STD AIDS. 2017 Mar;28(4):411-414. doi: 10.1177/0956462416665996. Epub 2016 Aug 20.
2. Okhremchuk I, Marmottant E, Abed S, Nguyen AT, Fournier B, Boye T, Morand JJ. A case of donovanosis acquired in France. Ann Dermatol Venereol. 2016 Nov;143(11):697-700. doi: 10.1016/j.annder.2016.03.011. Epub 2016 May 9. French.
3. Copeland NK, Decker CF.Other sexually transmitted diseases chancroid and donovanosis.
4. Dis Mon. 2016 Aug;62(8):306-13.
5. O'Farrell N, Moi H. 2016 European guideline on donovanosis. Int J STD AIDS. 2016 Jul;27(8):605-7.