Inguinal granuloma (donovanosis): causes, symptoms, diagnosis, treatment

Inguinal granuloma - a disease rare in the US, is caused by intracellular gram-negative bacteria Calymmatobacterium granulomatis. This disease is endemic in certain tropical and developing areas, including India, New Guinea, central Australia and southern Africa. Clinical manifestations of this disease are painless, progressive ulcerative lesions, not accompanied by regional lymphadenopathy. These lesions are abundantly vascularized (a kind of red beef) and bleed easily on contact. The microorganism causing this disease is not cultivated on standard nutrient media, and the diagnosis is based on the detection of donovan bodies in tissue preparations or in biopsy. It is possible to attach a secondary bacterial infection or identify the causative agent of another STD.

Treatment of inguinal granuloma (donovanosis)

Therapy stops the progressive destruction of tissues, although a long-term treatment is often required for the process of granulation and re-epithelialization of ulcers. Relapse can occur after 6-18 months, despite the effectiveness of initial therapy.

Recommended regimens for inguinal granuloma (donovanosis)

Trimethoprim-sulfamethoxazole 2 tablets orally 2 times a day for a minimum of 3 weeks,

Or Doxycycline 100 mg orally 2 times a day for a minimum of 3 weeks

Treatment should be continued until full healing of lesions occurs.

Alternative schemes

Ciprofloxacin 750 mg orally 2 times a day for a minimum of 3 weeks

Or Erythromycin 500 mg orally 4 times a day for a minimum of 3 weeks

For any of the above schemes, the addition of an aminoglycoside (gentamicin 1 mg / kg iv every 8 hours) is recommended if there is no improvement within the first few days.

Follow-up

Patients should be under clinical supervision until the signs and symptoms of the disease are resolved.

Management of sexual partners

Persons who have had sex with patients with inguinal granuloma should be examined and treated if: a) they have had sexual intercourse for 60 days, until symptoms appear in the patients, b) if they have symptoms and signs of the disease.

Special Remarks

Pregnancy

Pregnancy is a relative contraindication for the use of sulfonamides. Pregnant and lactating women should be treated with erythromycin. Parenteral administration of aminoglycosides (eg, gentamicin) is recommended.

HIV infection

Persons with HIV infection and inguinal granuloma should be treated according to the described treatment regimens. It is necessary to add parenterally aminoglycoside, such as gentamicin.

[1], [2], [3], [4], [5], [6]