Granuloma inguinale

Granuloma inguinale is a sexually-transmitted disease endemic to tropical/subtropical countries. Initial symptoms are nontender papules becoming beefy red granulomas that form fibrous tissue. Genital destruction may occur.

CASES/YEAR
1 (US); 2,000 (Global)
AGENT TYPE
Bacteria
OTHER NAMES
Donovanosis; Klebsiella granulomatis infection; Calymmatobacterium granulomatis infection;
ACUITY
Acute-Moderate
INCUBATION
7 days to 4 weeks; range of 3 days to 6 months; [Guerrant, p. 964] Probably from 1 to 16 weeks; [CCDM]
INITIAL SYMPTOMS
Nontender papules become beefy red granulomas that form fibrous tissue; [CCDM]
PRECAUTIONS
Standard;
COMMENTS
Granuloma inguinale is rare in industrialized countries. It is common among the poor in many tropical and subtropical countries. Genital destruction may occur. The disease may spread by direct contact; it has been reported in individuals who are sexually inactive. [CCDM, p. 267-9] The initial lesion is a papule that ulcerates "clean, with a red cobblestone base." The plaque slowly enlarges and may reach a size of 5-20 cm. Lesions of the cervix occur in women, and may be misdiagnosed as carcinoma. Lesions of the anus may be verrucous. Complications may include spread of the infection into bone and joints. [ID, p. 921] The primary skin lesion is described as, "a painless, red skin nodule slowly enlarges, becoming a raised, beefy red, moist, smooth, foul-smelling lesion." The lesions slowly spread to adjacent skin in the genital area and thighs. Lesions also spread by autoinoculation, and may occur on the face. Homosexual males may have lesions of the anus and buttocks. Secondary infection and scarring are common. Occasionally reported are cases with hematogenous spread (anemia, wasting, and infection of bone, joints, and liver). [Merck Manual, p. 1706] Granuloma inguinale may cause inguinal swelling (pseudobuboes), but not lymphadenopathy. [Guerrant, p. 1034]
DIAGNOSTIC
Presence of Donovan bodies within cells in smear or biopsy specimen; "A colorimetric PCR technique for rapid diagnosis is now available." [ID, p. 921]
SCOPE
Endemic in tropical/subtropical countries including central & northern Australia; southern India; Papua New Guinea; Guyana, Vietnam and occasionally in Latin America, Caribbean islands, and central, eastern & southern Africa; [CCDM]
SIGNS & SYMPTOMS
  • E nasal ulcers
  • E stomatitis
  • H anemia
  • S papules or plaques
  • S skin or subcutaneous nodule
  • S ulcer of skin
  • S warty growth of the skin
  • *arthritis
  • *osteomyelitis
  • *weight loss
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Skin or Mucous Membranes (Includes Conjunctiva), Sexual Contact
SOURCE
Person-to-Person
RESERVOIR
Human
RISK FACTORS
REFERENCES FOR CASES/YEAR
1. (US) Rarely diagnosed in the US; [Cecil, p. 1971]
2. (Global) A 1971 surveillance study found 5% prevalence in Papua New Guinea. 23% of males at a venereal disease clinic were infected. [ID, p. 1851] Rates of infection are decreasing in Australia, South Africa, India, Papua New Guinea, and the Caribbean. [PPID, p. 2844] 5,000 to 10,000 cases were reported in the US in 1947. The largest epidemic was in Dutch South Guinea with 10,000 cases in a population of 15,000 between 1922 and 1952. [Harrison ID, p. 587] Guesstimate: 2000 cases/year;