DonovanosisOverview

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.