What is this?
Granuloma inguinale, also known as Donovanosis, is a sexually transmitted infection caused by the bacterium Klebsiella granulomatis. It is caused by Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). It is transmitted Primarily through sexual contact. It can also be transmitted through non-sexual contact with infected lesions or contaminated objects. Granuloma inguinale is a chronic and potentially destructive infection, but with appropriate antibiotic treatment, it can be effectively managed and cured.
Granuloma inguinale,
also known as Donovanosis, typically presents with distinctive symptoms,
primarily affecting the genital and perineal areas. Here are the key symptoms:
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Nodular Lesions: The infection begins with small, painless nodules or
lumps in the genital or perineal area.
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Ulcers: The nodules break down to form beefy-red, granulomatous
ulcers. These ulcers have a characteristic velvety appearance and bleed easily
when touched.
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Edges: The edges of the ulcers are typically raised and rolled.
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Genital Area: Most commonly on the external genitalia, including the
penis, scrotum, labia, and vulva.
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Perineal Area: Lesions may also appear around the anus and perineum.
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Other Areas: In some cases, lesions can appear in the inguinal
region, mouth, pharynx, or abdomen through autoinoculation or spread.
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Spread of Ulcers: Without treatment, the ulcers can enlarge and coalesce,
leading to extensive tissue destruction.
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Scarring: Healing ulcers may leave significant scarring and
deformity.
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Superinfection: The ulcerated areas can become secondarily infected with
other bacteria, leading to additional symptoms like increased pain, swelling,
and discharge.
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Typically,
granuloma inguinale does not cause systemic symptoms such as fever or malaise.
It is primarily a localized infection.
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Scarring and Deformity: Significant tissue damage and scarring
can occur if the infection is not treated promptly.
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Lymphatic Obstruction: Chronic infection and scarring can lead
to obstruction of lymphatic vessels, causing lymphedema (swelling due to lymph
fluid buildup).
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Spread to Other Areas: Rarely, the infection can spread to
other parts of the body, including the bones, liver, and other organs, through
the bloodstream (hematogenous spread).
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Clinical Examination: Observation of characteristic lesions.
● Laboratory Tests: Detection of Donovan bodies (intracellular bacteria) in tissue smears or biopsy samples stained with Wright's or Giemsa stain.
How is it transmitted?
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Granuloma
inguinale, caused by the bacterium Klebsiella granulomatis, is primarily
transmitted through sexual contact( vaginal, anal, or oral). Transmission can
also occur through close genital contact even without penetration if the skin
or mucous membranes come into contact with infected secretions or lesions.
●
Rarely,
the infection can spread through direct contact with open ulcers or lesions on
the skin or mucous membranes. Though uncommon, transmission can potentially
occur through contact with contaminated objects (fomites) that have come into
contact with infected lesions.
● The bacteria can spread from one part of the body to another through autoinoculation. For example, touching an infected lesion and then touching another part of the body without washing hands can lead to the spread of the infection to new areas.
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Continued Treatment: Continue the antibiotic therapy until all
lesions are fully healed, which may take longer than 3 weeks in some cases.
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Test of Cure (TOC): Follow-up visits to ensure the infection
has cleared completely, and to monitor for potential recurrence of lesions.
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Reevaluation: If lesions do not respond to treatment or recur after
treatment, reevaluation and possibly extending or changing the antibiotic
regimen may be necessary.
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Antibiotic Resistance: Although Klebsiella granulomatis
generally responds well to the antibiotics listed, it is essential to follow up
and ensure that the treatment is effective.
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Partner Treatment: Sexual partners should be informed,
tested, and treated if necessary, to prevent reinfection and further spread.
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Avoiding Sexual Activity: Patients should abstain from sexual
activity until treatment is complete and follow-up tests confirm the infection
is cleared.
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Secondary Infections: If secondary bacterial infections occur,
additional antibiotics may be required.
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Scarring: Severe cases with significant tissue destruction may
require surgical intervention or reconstructive procedures after infection
clearance.
How to avoid it?
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Safe Sex Practices: Consistent and correct use of condoms
during all forms of sexual activity.
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Limiting Sexual Partners: Reducing the number of sexual partners
to lower the risk of exposure.
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Regular STI Screenings: Routine screening for sexually
transmitted infections for sexually active individuals, especially those at
higher risk.
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Prompt Treatment: Seeking immediate medical attention and
treatment if symptoms of granuloma inguinale or any other STI appear.