Granuloma inguinale is a progressive infection of genital and perineal skin caused by Klebsiella (formerly Calymmatobacterium) granulomatis. The disease is characterized by slowly progressive skin lesions that are beefy red, raised, painless, and often ulcerated; regional lymphadenopathy is uncommon. Diagnosis is by clinical criteria and microscopy. Treatment is with antibiotics, usually tetracyclines, macrolides, or trimethoprim/sulfamethoxazole.
(See also Overview of Sexually Transmitted Infections.)
Infections with Klebsiella granulomatis are extremely rare in high-resource countries but have been reported in areas such as Papua New Guinea, Australia, southern Africa, the Caribbean, and parts of Brazil and India.
Symptoms and Signs of Granuloma Inguinale
Sites of infection are
Penis, scrotum, groin, and thighs in men
Vulva, vagina, and perineum in women
Anus and buttocks in patients who engage in anal-receptive intercourse
Face in both sexes
After an incubation period of about 1 to 12 weeks, a painless, red skin nodule slowly enlarges, becoming a raised, beefy red, moist, smooth, foul-smelling lesion. The lesion slowly enlarges, often ulcerates, and may spread to other skin areas. Lesions heal slowly, with scarring. Secondary infections with other bacteria are common and can cause extensive tissue destruction. Lymphadenopathy is uncommon.
Occasionally, granuloma inguinale spreads through the bloodstream to the bones, joints, or liver; without treatment, anemia, wasting, and, uncommonly, death may occur.
This photo shows genital granuloma inguinale.
Image courtesy of Joe Miller and Dr. Cornelio Arevalo via the Public Health Image Library of the Centers for Disease Control and Prevention.
This photo shows genital granuloma inguinale.
Image courtesy of Dr. Susan Lindsley via the Public Health Image Library of the Centers for Disease Control and Prevention.
This photo shows perianal granuloma inguinale.
Image courtesy of Dr. Tabua via the Public Health Image Library of the Centers for Disease Control and Prevention.
Granuloma inguinale is a progressive ulcerative disease that is usually sexually transmitted and involves the skin and subcutaneous tissues in the anogenital and inguinal regions. The initial nodule slowly enlarges, erodes the surrounding tissues, and develops into a beefy, bulky, granulomatous mass.
© Springer Science+Business Media
This photo shows genital granuloma inguinale.
Image courtesy of Joe Miller and Dr. Cornelio Arevalo via the Public Health Image Library of the Centers for Disease Control and Prevention.
This photo shows genital granuloma inguinale.
Image courtesy of Dr. Susan Lindsley via the Public Health Image Library of the Centers for Disease Control and Prevention.
This photo shows perianal granuloma inguinale.
Image courtesy of Dr. Tabua via the Public Health Image Library of the Centers for Disease Control and Prevention.
Granuloma inguinale is a progressive ulcerative disease that is usually sexually transmitted and involves the skin and subcutaneous tissues in the anogenital and inguinal regions. The initial nodule slowly enlarges, erodes the surrounding tissues, and develops into a beefy, bulky, granulomatous mass.
© Springer Science+Business Media
Diagnosis of Granuloma Inguinale
Microscopic examination showing Donovan bodies in fluid from a lesion
Granuloma inguinale is suspected in patients from endemic areas with characteristic lesions.
Diagnosis of granuloma inguinale is confirmed microscopically by the presence of Donovan bodies (numerous bacilli in the cytoplasm of macrophages shown by Giemsa or Wright stain) in smears of fluid from scrapings from the edge of lesions. These smears contain many plasma cells.
Biopsy specimens are taken if the diagnosis is unclear or if adequate tissue fluid cannot be obtained because lesions are dry, sclerotic, or necrotic. The bacteria do not grow on ordinary culture media.
Treatment of Granuloma Inguinale
Antibiotics (various)
Many oral antibiotics kill the bacteria, but tetracyclines, macrolides, and trimethoprim/sulfamethoxazole (TMP/SMX) are most effective, followed by ceftriaxone, aminoglycosides, fluoroquinolones, and chloramphenicol.
Recommended oral regimen is azithromycin 1 g once a week or 500 mg a day for at least 3 weeks and continued until all lesions have completely healed.
Alternate oral regimens should be continued until all lesions have completely healed and include
Doxycycline 100 mg twice a day for at least 3 weeks or
TMP/SMX 160/800 mg twice a day for at least 3 weeks or
Erythromycin 500 mg four times a day for at least 3 weeks
IV or IM antibiotics (eg, ceftriaxone) are an alternative.
Response to treatment should begin within 7 days, but healing of extensive disease may be slow and lesions may recur, requiring longer treatment. HIV-infected patients may also require prolonged or intensive treatment. After apparently successful treatment, follow-up should continue for 6 months.
Current sex partners should be examined and, if infected, treated.
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