The diagnosis and treatment of donovanosis (granuloma inguinale)

Donovanosis is a predominantly tropical cause of genital ulcer occurring chiefly in small endemic foci in all continents except Europe. Diagnosis requires the careful collection, staining and examination of smears or biopsies of characteristic genital and, occasionally, extragenital lesions for demonstration of the pathognomonic Donovan bodies (Calymmatobacterium granulomatis) within histiocytes. Successful isolation of C. granulomatis has rarely proved feasible, the last report being in 1962. Donovanosis has a characteristic histopathological picture which occasionally simulates epithelioma. The antibiotics reported as showing good activity in donovanosis are those with good activity against gram negative bacilli and whose lipid solubility ensures good intracellular penetration. They include streptomycin, chloramphenicol, erythromycin, lincomycin, cotrimoxazole and the tetracyclines. More recently, good results have been reported with norfloxacin and thiamphenicol. The treatment of donovanosis in pregnant women and patients with AIDS poses special problems. Complications of donovanosis such as elephantiasis, stricture and pelvic abscess may require surgery. Contacts should be traced for examination but only treated if lesions are found.

Granuloma inguinale of the cervix: a carcinoma look-alike

Granuloma inguinale of the cervix presents as a proliferative growth and may mimic carcinoma. Over a 3 year period 18 patients with cervical granuloma inguinale were detected. Nine (50%) had a clinical diagnosis of carcinoma of the cervix on admission, five of whom had extensive investigations to exclude a malignancy. In communities where these two conditions are commonly seen it is recommended that granuloma inguinale be considered in young women with granulomatous lesions of the cervix, so as to avoid extensive and financially costly investigations, and unnecessary psychological stress for patients.

Accuracy of clinical diagnosis of genital ulcer disease

In Africa, establishment of an accurate clinical diagnosis in cases of genital ulcer disease is difficult owing to atypical presentation of ulcerations and mixed infections. This is compounded by the frequent lack of suitable laboratory facilities. In 240 cases of genital ulcer disease among mineworkers in Carletonville, South Africa, this study endeavored to correlate the clinical diagnosis with laboratory findings. Clinical accuracy and positive and negative predictive values were determined for each type of genital ulcer disease encountered. Overall, the accuracy of clinical diagnosis was 68% for single infections, 80% for chancroid, 55% for primary syphilis, 27% for lymphogranuloma venereum (LGV), and 22% for genital herpes. Adequate laboratory facilities are indispensible for the establishment of an accurate etiologic diagnosis of genital ulcer disease and thus the institution of appropriate antimicrobial therapy.

Granuloma gluteale infantum: case report and review of the literature

Granuloma gluteale infantum, a benign granulomatous eruption involving the gluteal region, histologically shows a nonspecific dermal inflammatory infiltrate composed of neutrophils, lymphocytes, histiocytes, plasma cells, and eosinophils. It is important to recognize this condition, as it may clinically simulate a neoplastic process. It arises as a complication of primary irritant diaper dermatitis, however, and typically resolves without treatment.

Diagnosis of an unusual abdominal presentation of granuloma inguinale by fine needle aspiration cytology

A 63-year-old Hispanic man from Peru who recently had immigrated to the United States presented with progressive weakness, weight loss, recurrent abdominal pain and passing bright red blood per rectum. Rectal carcinoma was suspected. Biopsies of two lesions in the sigmoid colon showed granuloma inguinale (donovanosis). A computed tomographic scan of the abdomen revealed a large presacral mass. A radiographically guided fine needle aspiration (FNA) of the presacral mass showed findings characteristic of granuloma inguinale. FNA thus proved to be a useful adjuvant in the diagnosis of an unusual case of granuloma inguinale (donovanosis) presenting with a presacral mass that had the radiologic characteristics of a malignant tumor.

A rapid stain for the diagnosis of granuloma inguinale

Tissue smears were prepared from 55 men and eight women with genital ulceration using two staining techniques and examined by direct microscopy for the presence of Donovan bodies. Twenty three smears were positive using the May-Grunwald-Giemsa staining method and 23 were positive using a rapid technique, the RapiDiff stain. The RapiDiff technique is suitable for use in the diagnosis of granuloma inguinale (donovanosis) in busy sexually transmitted diseases clinics in the developing world.

Extragenital granuloma inguinale mimicking a soft-tissue neoplasm: a case report and review of the literature

Granuloma inguinale has been reported to mimic squamous cell carcinoma, as well as sexually transmitted diseases. We describe a rare case of extragenital granuloma inguinale that mimicked a soft tissue neoplasm in an 18-year-old pregnant woman who presented with cervical and labial ulcers. An elective cesarean section was performed, at which time a retroperitoneal mass that involved the right ureter was found. At frozen section, the mass had a xanthogranulomatous appearance consistent with a soft-tissue neoplasm. Special stains of the permanent sections revealed the pathognomic features of granuloma inguinale.

Lymphogranuloma venereum, chancroid, and granuloma inguinale

Lymphogranuloma venereum, chancroid, and granuloma inguinale are three uncommon bacterial infections in the United States; however, with the increase in immigrants from Asian and South American countries, the incidence of these infections is rising. This article reviews the clinical manifestations, diagnosis, and therapy of these infections.

Chancroid and granuloma inguinale

Haemophilus ducreyi is a fastidious pathogen that can be routinely cultured with the appropriate media and incubation environment. Prostituted women appear to be the usual reservoir. In Africa, chancroid is emerging as the major risk factor for acquisition of HIV-1 following heterosexual intercourse. Despite the emergence of resistance to a number of antimicrobial agents, H. ducreyi remains susceptible to ceftriaxone, erythromycin, and ciprofloxacin. Control and eradication of outbreaks of chancroid have been successful on several occasions in Western societies; strategies to control epidemic genital ulcer disease are required in developing countries. Granuloma inguinale is caused by a small, gram-negative rod, which has never been well-characterized. The presence of Donovan bodies is a specific and sensitive diagnostic characteristic. Very little is known about the epidemiology of the disease. Specific treatment programs using trimethoprim-sulfamethoxazole or erythromycin seem to be quite effective. Control strategies have not been adequately investigated.

Granuloma inguinale of cervical lymph nodes simulating tuberculous lymphadenitis: two case reports and review of published reports

Granuloma inguinale (donovanosis) is commonly thought to be a superficial disease, which spreads by continuity and does not affect the regional lymph nodes. Two patients with the disease affecting lymph nodes in the neck are reported from a series of 108 seen in a continuing study of granuloma inguinale. An immunofluorescent antibody test is described that showed antigenic relatedness between the intracellular organisms in these patients and in patients with typical genital granuloma inguinale. Lymphadenitis associated with granuloma inguinale appears to be a stage in the pathogenesis of the pseudobubo, an uncommon feature of this disease.

The treatment of donovanosis (granuloma inguinale)

Over a two-year period, 37 patients with genital ulcer disease attending a clinic for sexually transmitted diseases in Harare were found to have donovanosis. Of the 37 patients, 25 were male, and 12 were female; all presented with painless, indurated, granulating ulcers without lymph-node involvement. The lesions were more extensive in pregnant women. All patients responded well to either a combination of intramuscular streptomycin plus oral tetracycline given over 14 days, or a 14-day course of oral co-trimoxazole (trimethoprim-sulfamethoxazole). No metastatic lesions were found.

Granuloma inguinale. Report of the first case in Qatar

The first known case of granuloma inguinale in the State of Qatar was observed in an Indian expatriate who contracted the disease in India. The patient had the ulcero-vegetative clinical variant of the disease, which was suspected from the history, lack of spontaneous healing for five months, and the typical clinical picture. The diagnosis was confirmed by the finding of intracellular Donovan bodies in a crushed-tissue smear stained with Wright's stain. The patient was treated by tetracycline hydrochloride (2 g daily for 20 days). The ulcer was healed completely within ten days. The diagnosis of more cases of granuloma inguinale in Qatar is anticipated because of the recent improvement of health care, medical records, and attraction of medical attention to the disease.

Granuloma inguinale (donovanosis) of the oral cavity. A case report

A case of granuloma inguinale of the oral cavity clinically resembling actinomycosis is reported. This condition should be considered in the differential diagnosis of chronic ulcerative lesions of the mouth, especially in patients with associated genital ulcers.

Sexually transmitted diseases

This article summarizes the major sexually transmitted diseases with an emphasis on diagnosis, therapy, and follow-up. Topics included are syphilis, gonorrhea, herpes genitalis, nongonococcal urethritis, lymphogranuloma venereum, granuloma inguinale, chancroid, condyloma acuminatum, molluscum contagiosum, and venereally transmitted gastrointestinal disease.