Granuloma inguinale, also known as donovanosis, is a rare sexually transmitted infection (STI) caused by the bacterium Klebsiella granulomatis. This chronic bacterial disease primarily affects the genital and groin regions, causing ulcerative lesions that can severely damage skin and underlying tissues if left untreated.
Causes of Granuloma Inguinale
Granuloma inguinale is caused by Klebsiella granulomatis, a gram-negative intracellular bacterium. Transmission occurs through direct sexual contact with an infected individual. While rare in developed countries, granuloma inguinale is more prevalent in tropical and subtropical regions such as India, Papua New Guinea, the Caribbean, and parts of Africa.
Symptoms of Granuloma Inguinale
Symptoms of granuloma inguinale may take weeks or even months to appear after exposure. The primary signs include:
- Painless ulcers: Progressive lesions appear as beefy-red nodules that ulcerate over time.
- Bleeding: The ulcers may bleed easily upon contact.
- Tissue destruction: If untreated, the ulcers may expand and destroy surrounding tissue.
- Malodorous discharge: A foul-smelling discharge may develop in severe cases.
- Swollen lymph nodes: While less common, lymph node involvement can occur.
Stages of Granuloma Inguinale
Granuloma inguinale can progress through distinct stages:
- Nodular stage: Firm, raised nodules form in the genital area.
- Ulcerative stage: Lesions break down, creating bleeding ulcers.
- Hypertrophic stage: Granulation tissue enlarges, forming exuberant growths.
- Sclerotic stage: Scar tissue and fibrosis develop in chronic cases.
Risk Factors
Several factors increase the risk of contracting granuloma inguinale:
- Unprotected sexual activity
- Multiple sexual partners
- Poor personal hygiene
- Living in or traveling to endemic regions
- HIV and other immunocompromised conditions
Diagnosis of Granuloma Inguinale
Diagnosing granuloma inguinale involves the following steps:
- Physical examination: Identification of characteristic lesions.
- Microscopic examination: Tissue samples stained with Giemsa or Wright’s stain reveal Donovan bodies, which confirm the presence of Klebsiella granulomatis.
- Culture tests: Although less common, bacterial cultures can provide confirmation.
- Polymerase chain reaction (PCR): Molecular testing can detect bacterial DNA for precise diagnosis.
Treatment of Granuloma Inguinale
Early diagnosis and treatment are crucial to prevent complications. The following antibiotics are commonly prescribed:
- Azithromycin (preferred choice)
- Doxycycline
- Erythromycin
- Ciprofloxacin
- Trimethoprim-sulfamethoxazole
Treatment Duration
Treatment typically continues for at least three weeks or until all lesions have healed completely. In some cases, extended therapy may be required to prevent relapse.
Complications
If untreated, granuloma inguinale can lead to:
- Extensive genital destruction
- Permanent scarring
- Genital lymphedema (elephantiasis)
- Increased risk of secondary bacterial infections
- Possible association with squamous cell carcinoma in chronic cases
Prevention Strategies
To reduce the risk of granuloma inguinale:
- Practice safe sex by using condoms.
- Maintain good personal hygiene.
- Seek prompt medical attention for any suspicious genital lesions.
- Screen sexual partners in case of exposure.
FAQs:
Is granuloma inguinale curable?
Yes, with appropriate antibiotic treatment, granuloma inguinale is curable.
How is granuloma inguinale different from syphilis?
While both conditions cause genital ulcers, granuloma inguinale ulcers are typically painless and bleed easily, whereas syphilis ulcers are usually firm and non-bleeding.
Can granuloma inguinale recur after treatment?
Recurrence is possible, especially if treatment is incomplete. Regular follow-ups are recommended.
Is granuloma inguinale contagious?
Yes, it spreads primarily through sexual contact. Close contact with infected skin can also contribute to transmission.
Can granuloma inguinale affect fertility?
In advanced cases with severe scarring, granuloma inguinale may impair fertility.
Granuloma inguinale is a rare yet serious bacterial infection that requires prompt diagnosis and treatment. Understanding its causes, symptoms, and preventive measures is essential for minimizing risks and ensuring effective management. If you suspect any symptoms of granuloma inguinale, consult a healthcare provider immediately.
