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Skin layers
Skin layers

Granuloma inguinale
Definition:
In the United States granuloma inguinale is a rarely encountered sexually-transmitted disease that results in surface destruction and granuloma formation in the skin and subcutaneous tissue.

Alternative Names:
Donovanosis

Causes, incidence, and risk factors:
Granuloma inguinale is a bacterial disease caused by the organism Calymmatobacterium granulomatis. The disease is commonly found (endemic) in the tropical and subtropical areas of the world (such as Southeast India, Guyana, and New Guinea), but it occurs on occasion in the United States (typically in the Southeast). There are approximately 100 cases reported per year in the United States.

Men are more often affected than women, with a ratio of 2.5 to 1. Peak incidence occurs between 20 and 40 years old. The disease is seldom seen in children or the elderly. It is thought that anal intercourse, rather than vaginal intercourse, is the most frequent source of infection. About 50% of the infected men and women have lesions in the anal area also.
Symptoms:
  • Small beefy-red bump (papule) on the genitalia or the perianal area that gradually eats away (erodes) the skin and forms an elevated beefy red velvety nodule (granulation tissue)
  • These nodules are usually painless and bleed easily if traumatized
  • Gradual spreading with erosion and destruction of genital tissue
  • Spread of disease to the inguinal folds (where the legs meet the torso)
  • Depigmentation of the genitals and surrounding skin
  • Untreated disease results in mutilation and destruction of the genital tissue.

In its early stages, it may be difficult to differentiate granuloma inguinale from chancroid. In the later stages, granuloma inguinale may resemble advanced genital cancers, lymphogranuloma venereum, and anogenital cutaneous amebiasis.
Signs and tests:
Classically, the diagnosis of granuloma inguinale should be considered if genital lesions have been present for a long time and have been progressively enlarging. Serological tests such as that used to detect syphilis are available only on a research basis for diagnosing granuloma inguinale.

Tests that may be performed include:
Treatment:
A complete cure of granuloma inguinale requires fairly long treatment. Most treatment courses run 3 weeks or until the lesions have completely healed. The antibiotics used include:
  • Tetracycline or doxycycline
  • Sulfamethoxazole
  • Gentamicin
  • Streptomycin
  • Ciprofloxacin
  • Erythromycin
A follow-up examination is essential because the disease can reappear after an apparently successful cure.
Expectations (prognosis):
If the disease is treated early, no resultant tissue destruction or scarring should occur. Untreated disease can lead to complications. In addition, if the disease becomes disseminated (widely distributed throughout the body), death may result from secondary problems such as heart failure, pneumonia, or hemorrhage.
Complications:
  • Genital destruction and scarring
  • Genital depigmentation (loss of skin color)
  • Permanent genital swelling (edema) from lymphatic scarring
Calling your health care provider:
Call for an appointment with your health care provider if you have had sexual exposure to a person who is known to have granuloma inguinale, or if you develop symptoms similar to those listed above.
Prevention:
Granuloma inguinale is a sexually-transmitted disease. Although there are few cases in the United States, safe sex practices will prevent the spread of granuloma inguinale as well as other sexually-transmitted diseases. Sexual contact with people living in tropical and subtropical climates increases the likelihood of exposure.
Review Date: 7/24/2001
Reviewed By: Camille Kotton, M.D., Infectious Diseases Division, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.
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