Granuloma inguinale (Donovanosis).

Granuloma inguinale (Donovanosis).

Granuloma inguinale is a genital ulcerative disease caused by the intracellular Gram-negative bacterium Calymmatobacterium granulomatis.

Clinical features

Presents as painless, progressive ulcerative lesions without regional lymphadenopathy.
 
The lesions are highly vascular ("beefy red appearance") and bleed easily on contact. However, the clinical presentation can also include hypertrophic, necrotic or sclerotic variants.
The causative organism is difficult to culture, and diagnosis requires visualisation of dark-staining Donovan bodies on tissue crush preparation or biopsy.

Treatment

Treatment stops progression of lesions, although prolonged therapy may be required to permit granulation and re-epithelialisation of the ulcers.
Treatment with antibiotics is required for at least 3 weeks. Effective regimens include:
Doxycycline 100 mg orally twice a day.
Trimethoprim-sulphamethoxazole one double-strength (800mg/160mg) tablet orally twice a day.
Ciprofloxacin 750 mg orally twice a day.
Erythromycin base 500 mg orally four times a day.
Azithromycin 1 g orally once per week.