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Muller EE, Kularatne R. The changing epidemiology of genital ulcer disease in South Africa: has donovanosis been eliminated? Sex Transm Infect 2020; 96:596-600. [PMID: 32075875 DOI: 10.1136/sextrans-2019-054316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We used an in-house molecular assay for the detection of Klebsiella granulomatis in ulcer specimens collected over a 12-year surveillance period in order to determine whether a diagnosis of donovanosis could be ascribed to genital ulcer disease (GUD) of unknown aetiology in our setting. METHODS Between 2007 and 2018, a total of 974 genital ulcer specimens with no previously identified sexually transmitted (STI) pathogens were selected from STI aetiological surveys conducted in all nine provinces of South Africa. Giemsa-stained ulcer smears from the same participants had previously been routinely analysed for the presence of typical Donovan bodies within large mononuclear cells. A Klebsiella screening assay targeting the phoE (phosphate porin) gene was used in combination with restriction digest analysis and sequencing to confirm the presence of K. granulomatis. RESULTS The Klebsiella screening assay tested positive in 19/974 (2.0%) genital ulcer specimens. Restriction digest analysis and nucleotide sequencing of the phoE gene confirmed that none of these specimens was positive for K. granulomatis DNA. Similarly, Donovan bodies were not identified in the Giemsa stained ulcer smears of these specimens. CONCLUSIONS This is the first study to assess K. granulomatis as a cause of genital ulceration in South Africa over a 12-year surveillance period using molecular methods. The results demonstrate that K. granulomatis is no longer a prevalent cause of GUD in our population.
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Affiliation(s)
- Etienne E Muller
- STI Section, Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ranmini Kularatne
- STI Section, Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa.,Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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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; 143:697-700. [PMID: 27174716 DOI: 10.1016/j.annder.2016.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/09/2016] [Accepted: 03/10/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Donovanosis (granuloma inguinale) is a bacterial infection caused by Klebsiella granulomatis that occurs mainly in the genital area and is primarily sexually transmitted; it is seen predominantly in the tropics. Herein, we report a case of the disease contracted in metropolitan France. PATIENTS AND METHODS A 47-year-old man presented with painless ulceration of the glans, present for one month, with progressive extension; there was no history of any recent trip abroad. Skin biopsy with Whartin-Starry and Giemsa staining revealed Donovan bodies in the cytoplasm of macrophages. Based on these findings, further questioning of the patient revealed unprotected sexual contact two months earlier in France. Treatment was initiated with azithromycin 1g on the first day followed by 500mg per day for three weeks. The clinical outcome was spectacular, with almost complete regression of the ulcer at 7 days. DISCUSSION This case demonstrates that donovanosis can occur in metropolitan France.
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Affiliation(s)
- I Okhremchuk
- Service d'anatomie et cytologie pathologiques, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France; Service de dermatologie et de vénérologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France.
| | - E Marmottant
- Service de dermatologie et de vénérologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France
| | - S Abed
- Service de dermatologie et de vénérologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France
| | - A-T Nguyen
- Service d'anatomie et cytologie pathologiques, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France
| | - B Fournier
- Service de dermatologie et de vénérologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France
| | - T Boye
- Service de dermatologie et de vénérologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France
| | - J-J Morand
- Service de dermatologie et de vénérologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France
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Cardoso JC, Calonje E. Cutaneous infections presenting with granulomatous infiltrates: a review of histopathological patterns. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.mpdhp.2013.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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4
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Mindel A, Dwyer D, Herring B, Cunningham AL. Global Epidemiology of Sexually Transmitted Diseases. Sex Transm Dis 2013. [DOI: 10.1016/b978-0-12-391059-2.00001-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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5
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Rosen T, Vandergriff T, Harting M. Antibiotic Use in Sexually Transmissible Diseases. Dermatol Clin 2009; 27:49-61. [DOI: 10.1016/j.det.2008.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Condon JR, Rumbold AR, Thorn JC, O’Brien MM, Davy MJ, Zardawi I. A cluster of vulvar cancer and vulvar intraepithelial neoplasia in young Australian Indigenous women. Cancer Causes Control 2008; 20:67-74. [DOI: 10.1007/s10552-008-9218-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 07/31/2008] [Indexed: 11/29/2022]
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Mackay IM, Harnett G, Jeoffreys N, Bastian I, Sriprakash KS, Siebert D, Sloots TP. Detection and discrimination of herpes simplex viruses, Haemophilus ducreyi, Treponema pallidum, and Calymmatobacterium (Klebsiella) granulomatis from genital ulcers. Clin Infect Dis 2006; 42:1431-8. [PMID: 16619156 DOI: 10.1086/503424] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 01/17/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Genital ulcer disease (GUD) is commonly caused by pathogens for which suitable therapies exist, but clinical and laboratory diagnoses may be problematic. This collaborative project was undertaken to address the need for a rapid, economical, and sensitive approach to the detection and diagnosis of GUD using noninvasive techniques to sample genital ulcers. METHODS The genital ulcer disease multiplex polymerase chain reaction (GUMP) was developed as an inhouse nucleic acid amplification technique targeting serious causes of GUD, namely, herpes simplex viruses (HSVs), H. ducreyi, Treponema pallidum, and Klebsiella species. In addition, the GUMP assay included an endogenous internal control. Amplification products from GUMP were detected by enzyme linked amplicon hybridization assay (ELAHA). RESULTS GUMP-ELAHA was sensitive and specific in detecting a target microbe in 34.3% of specimens, including 1 detection of HSV-1, three detections of HSV-2, and 18 detections of T. pallidum. No H. ducreyi has been detected in Australia since 1998, and none was detected here. No Calymmatobacterium (Klebsiella) granulomatis was detected in the study, but there were 3 detections during ongoing diagnostic use of GUMP-ELAHA in 2004 and 2005. The presence of C. granulomatis was confirmed by restriction enzyme digestion and nucleotide sequencing of the 16S rRNA gene for phylogenetic analysis. CONCLUSIONS GUMP-ELAHA permitted comprehensive detection of common and rare causes of GUD and incorporated noninvasive sampling techniques. Data obtained by using GUMP-ELAHA will aid specific treatment of GUD and better define the prevalence of each microbe among at-risk populations with a view to the eradication of chancroid and donovanosis in Australia.
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Affiliation(s)
- Ian M Mackay
- Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewski Virus Research Centre, Royal Children's Hospital, Queensland, Australia.
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Wu JJ, Huang DB, Pang KR, Tyring SK. Selected sexually transmitted diseases and their relationship to HIV. Clin Dermatol 2005; 22:499-508. [PMID: 15596321 DOI: 10.1016/j.clindermatol.2004.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although sexually transmitted diseases (STDs) are underreported and underrecognized, they are a major source of morbidity, mortality, and represent a major socioeconomic cost in developing and industrialized nations. Individuals who develop STDs are often coinfected with human immunodeficiency virus (HIV). Coinfection with HIV both facilitates the natural history of STDs and worsens the clinical picture. The objective of this article is to provide a review to the practicing clinician on the epidemiology, clinical manifestations, methods of diagnosis, and treatment for four cutaneous STDs--chancroid, genital herpes, granuloma inguinale, and lymphogranuloma venereum--in coinfected HIV patients.
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Affiliation(s)
- Jashin J Wu
- Department of Dermatology, University of California College of Medicine Irvine, Irvine, California, USA
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Clyti E, Couppié P, Strobel M, Cazanave C, Sainte-Marie D, Pradinaud R. [Short treatment of donovanosis with azithromycin]. Ann Dermatol Venereol 2004; 131:461-4. [PMID: 15235534 DOI: 10.1016/s0151-9638(04)93640-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Azithromycine is recommended in the treatment of donovanosis with a 7-day treatment cycle. We report the efficacy of a single cure of 1 gram in two patients. OBSERVATIONS Four patients, presenting with donovanosis, were treated with azithromycine according to 2 regimens. The first used 500 mg/d the molecule during 1 week, the second used azithromycine in single cure of 1 gram. The latter led to the complete cure of 2 patients. DISCUSSION Many antibiotics are used in the treatment of donovanosis. Since 1996, Australian authors have used azithromycine in this indication. A single dose of this molecule appears effective in recent and confined donovanosis.
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Affiliation(s)
- E Clyti
- Service de Dermatologie, Centre Hospitalier Andrée Rosemon, BP 6006, 97306 Cayenne, Guyana.
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Abstract
Sexually transmitted infections (STIs) are notable for their fastidious requirements for transmission and growth in the laboratory and for their high physical and psychosocial morbidity. The combination of subtle or absent symptoms and stigma preventing the seeking of health care, leaves many infections undiagnosed. The development of nucleic-acid amplification tests heralded a new era in sensitive and robust diagnostic procedures for STIs. Unfortunately, many of these tests are not commercially available or are too expensive for the populations that need them most. Single-dose oral azithromycin has improved the treatment of several bacterial STIs, but quinolones are rapidly becoming ineffective for gonorrhoea. Self-treatment of genital warts with podophyllotoxin or imiquimod preparations is attractive to patients and might be cost effective for health services. The prospect of effective vaccines against genital papillomaviruses in the near future is real. Such vaccines could reduce the global incidence of some anogenital cancers. Episodic treatment of genital herpes is getting easier and cheaper, and suppressive treatment can reduce transmission to regular sexual partners. A vaccine against herpes simplex virus type 2 has shown some limited efficacy. Ultimately, better control of STIs, and reduction of their contribution to the spread of HIV, will require a broad health-sector response with adequate resourcing, and a change in social and political attitudes.
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Affiliation(s)
- Basil Donovan
- School of Public Health, University of Sydney, NSW 2006, Australia.
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Abstract
Donovanosis, a chronic cause of genital ulceration, has recently been the subject of renewed interest after a long period of relative obscurity. The causative organism, Calymmatobacterium granulomatis, has been cultured for the first time in many years and a polymerase chain reaction diagnostic using a colorimetric detection system has been developed. Phylogenetic analysis confirms close similarities with the genus Klebsiella and a proposal made that C granulomatis be reclassified as Klebsiella granulomatis comb nov. Azithromycin has emerged as the drug of choice and should be used if the diagnosis is confirmed or suspected. In donovanosis endemic areas, syndromic management protocols for genital ulceration may need to be adapted locally. A significant donovanosis epidemic was reported in Durban from 1988-97 but the current status of this epidemic is unclear. The donovanosis elimination programme among Aboriginals in Australia appears successful and is a model that could be adopted in other donovanosis endemic areas. Overall, the incidence of donovanosis seems to be decreasing. Increased attention would undoubtedly be paid to donovanosis if policy makers recognised more readily the importance of genital ulcers in fuelling the HIV epidemic.
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Dubb M, Hale M. Donovanosis of the face in a patient with HIV infection: a case report. Cytopathology 2002. [DOI: 10.1046/j.1365-2303.2001.00326.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Roest RW, van der Meijden WI. European guideline for the management of tropical genito-ulcerative diseases. Int J STD AIDS 2001; 12 Suppl 3:78-83. [PMID: 11589803 DOI: 10.1258/0956462011923994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- R W Roest
- Department of Dermatovenereology, University Hospital Dijkzigt, Rotterdam, The Netherlands.
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Czelusta A, Yen-Moore A, Van der Straten M, Carrasco D, Tyring SK. An overview of sexually transmitted diseases. Part III. Sexually transmitted diseases in HIV-infected patients. J Am Acad Dermatol 2000; 43:409-32; quiz 433-6. [PMID: 10954653 DOI: 10.1067/mjd.2000.105158] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
UNLABELLED The HIV epidemic has dramatically altered the field of sexually transmitted diseases (STDs). HIV infection is unique among sexually transmitted diseases because it can modify the clinical presentation and features of other STDs. Conversely, other STDs can affect the transmission of HIV. This review is the third part of a series that has provided a general overview of STDs. In this article, genital ulcer diseases (genital herpes, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale), human papillomavirus infection (anogenital warts and subclinical infections), molluscum contagiosum, human herpesvirus 8 infection, viral hepatitis, and ectoparasitic infestations (scabies and pediculosis pubis) are discussed as they occur in HIV-infected hosts. Additional features as they relate to HIV-infected patients, such as epidemiology and transmission, are discussed when applicable. LEARNING OBJECTIVE At the conclusion of this learning activity, participants should improve their understanding of sexually transmitted diseases in the HIV-infected host.
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Affiliation(s)
- A Czelusta
- Department of Dermatology at the University of Texas- Houston Health Science Center and St Joseph Hospital, Houston, USA
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Carter JS, Kemp DJ. A colorimetric detection system for Calymmatobacterium granulomatis. Sex Transm Infect 2000; 76:134-6. [PMID: 10858717 PMCID: PMC1758278 DOI: 10.1136/sti.76.2.134] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To incorporate the first polymerase chain reaction (PCR) assay for Calymmatobacterium granulomatis into a colorimetric detection system for use in routine diagnostic laboratories. METHODS A capture oligonucleotide specific for the Klebsiella phoE gene was covalently linked to tosyl activated magnetic beads. Biotinylated phoE PCR products obtained from 14 positive specimens from patients with donovanosis and isolates of Klebsiella pneumoniae, K rhinoscleromatis, and K ozaenae were cleaved with HaeIII for the purpose of differentiation, captured by the prepared beads, and subjected to standard EIA detection methodology. Eight samples from unrelated genital conditions underwent the same procedure. It was anticipated from the sequence data that the biotinylated fragment would be cleaved from the capture oligonucleotide target region in the three Klebsiella phoE products (that is, a negative colorimetric result) while the entire fragment of interest would remain intact in the positive C granulomatis phoE products (that is, a positive colorimetric result). RESULTS All 14 positive specimens from patients with donovanosis gave strong colorimetric readings with this detection system. Isolates of K pneumoniae, K rhinoscleromatis, K ozaenae, and the eight specimens from unrelated genital conditions were negative. CONCLUSION The successful development of a colorimetric detection system for C granulomatis incorporating two levels of specificity enables the molecular diagnosis of this condition to be undertaken by routine diagnostic laboratories. This should have an important role in the Australian government's campaign to eradicate donovanosis by 2003 though the test still needs to undergo trials and be validated using a larger number of samples from geographically diverse parts of the world in order to ascertain the generalisability of the methodology.
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Affiliation(s)
- J S Carter
- Centre for Indigenous Natural and Cultural Resource Management, Faculty of Aboriginal, Northern Territory University, Darwin, Australia.
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GLOBAL EPIDEMIOLOGY OF SEXUALLY TRANSMITTED DISEASES. Sex Transm Dis 2000. [DOI: 10.1016/b978-012663330-6/50002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Sexually Transmitted Bacterial Diseases. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Rautio M, Jousimies-Somer H, Kauma H, Pietarinen I, Saxelin M, Tynkkynen S, Koskela M. Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG. Clin Infect Dis 1999; 28:1159-60. [PMID: 10452653 DOI: 10.1086/514766] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- M Rautio
- Anaerobe Reference Laboratory, National Public Health Institute, Helsinki, Finland.
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