Granuloma Inguinale (Donovanosis): Symptoms, Stages, Causes & Treatment
Granuloma inguinale is a genital ulcerative disease caused by the bacterium Klebsiella granulomatis. That is, Granuloma inguinale is a sexually transmitted infection (STI). Also known as donovanosis, the infection causes lesions in the genital and anal regions . The STI is characterised by pain-free genital ulcers that look like the pox. The infection is mostly found in sub-tropical and tropical regions and is rarely reported in developed countries. In some of the developing countries, such as India, Papua New Guinea, and the Caribbean, the infection is regarded as an endemic , .
The bacterium Klebsiella granulomatis infects the skin around the genitals and causes ulcers which result in the destruction of the skin around the affected area. This destructive nature of the infection elevates the risk of getting affected by other pathogenic microbes.
Granuloma inguinale is infectious, that is, it can spread from one person to other . It is mostly spread through the means of vaginal or anal intercourse and rare cases of infection through oral sex have been reported. However, anal intercourse is suspected to be the most frequent source of infection. About 50 per cent of the affected (men and women) have developed lesions in the anal region .
Studies have revealed that men are most likely to be affected by the infection than women and commonly occurs in people aged between 20 to 40. Most of the cases of the STI reported are in people who have travelled to places that are at a high risk of the infection . And, a very small proportion of people may be infected through direct, non-sexual contact (skin to skin).
The common signs indicating the development of the infection are small, painless nodules (pimple like) which develops into an open and fleshy lesion. The infection develops in the genital area and in some cases, mouth sores can also develop. This aggravates until the infected tissue gets mutilated and the infection will continue to latch onto other tissues , .
Apart from this, the symptoms of the sexually transmitted disease can be described in line with the stages of Granuloma inguinale.
The signs of the infection develop at a slow pace. That is, once the individual comes in contact with the bacteria it will take 7 to 10 days to experience the symptoms. Within a period of 12 weeks, the symptoms will be at their maximum capacity .
The infection is caused by the Klebsiella granulomatis bacteria. One can contract the infection by having vaginal or anal intercourse with an infected partner. In very rare cases, it has spread through oral sex. Apart from these, it can spread from a mother to a child during delivery .
It is often difficult to diagnose the infection in its early stage due to the slow development of the ulcers.
If the ulcers do not heal after a month, your doctor will advise a skin biopsy of the lesions called the punch biopsy. Under this one, the doctor will remove a small area of the ulcer with a circular blade and will be tested for the presence of Klebsiella granulomatis bacteria . In some cases, scrapings of the lesions are used to detect the presence of the bacteria.
The diagnosis will also include blood tests to check the presence of other sexually transmitted diseases , .
Antibiotics such as azithromycin, doxycycline, ciprofloxacin, erythromycin, and trimethoprim-sulfamethoxazole are used. The antibiotics will be used for a long period of time, until the sores are completely healed, and depending on the length of time since infection and the stage of infection. Most of the antibiotics are prescribed for a period of three weeks, however, some may take more time to heal the ulcer .
If the ulcers are painful, the doctor will advise for painkillers .
A follow-up examination is essential, as the sexually transmitted infection can reappear even if the lesions have gone down completely .
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