Donovanosis

Granuloma inguinale” (GI) is a sexually transmitted disease that occurs in certain areas worldwide and is associated with extensive ulceration and even mutilation. It is caused by bacteria found only in humans and is curable with antibiotics.

Of microbes and humans

For a long time, the pathogen went by the unpronounceable name Calymmatobacterium granulomatis. After detection methods became more sophisticated, it was discovered to be related to Klebsiae, a bacterial genus whose species, Klebsiella pneumoniae, normally lives peacefully in the human gastrointestinal tract and can cause urinary and respiratory tract infections only in immunocompromised individuals. He was then allowed to join the clan as a belligerent member “Klebsiella granulomatis”. The pathogens are passed on through contact with the ulcers, especially during unprotected vaginal and anal intercourse, but more rarely through fingers or from the mother to the child during birth. People from socially deprived backgrounds and poor hygienic conditions are particularly affected. For example, indigenous people are more likely to be infected in Australia and Papua New Guinea, black people in the USA, and Hindus rather than Muslims in India. Which gender predominates varies depending on the study, but most experts assume an equal distribution. The highest rate of infection is among 20- to 40-year-olds. Since the disease usually progresses untreated and those affected often seek medical care late in life, e.g. for reasons of shame or cost, pronounced courses of the disease can often be observed. Donovanosis and HIV infections occur together in clusters and mutually increase the risk of infection.

Hard facts and dark numbers

GI occurs regularly in the

  • Caribbean, southern India,
  • Southern Africa,
  • Papua New Guinea, Southeast Asia,
  • Australia and Brazil before.

In Australia, a few years ago, an attempt was made to eradicate the disease, which until then was present in up to 10% of the indigenous population. Although this has not been completely successful, the disease numbers have declined sharply through education, prevention and early treatment. In other countries, GI occurs only sporadically – in the USA, for example, fewer than 100 cases are registered each year, presumably mostly travelers’ souvenirs. There are no figures for Germany.

Symptoms and course

With granuloma inguinale, as with many other STDs, “nomen est omen” applies: Inflammatory nodular tissue neoplasms (granulomas) occur in the groin (inguinal). However, since this sign is not specific, is not unique to the groin, and is present in only an estimated 10-15% of affected individuals, the term donovanosis is preferred today. This is derived from the Donovan corpuscles (named after a tropical doctor), an accumulation of the pathogens in certain immune cells. By the way, since donovanosis is also called granuloma venerum, there is a risk of confusion with lymphogranuloma venereum , another venereal disease! About 10-40 days after infection, small, blue-red, painless ulcers appear at the site of contact – usually penile shaft, labia or anal region. Later, these break open and secrete fluid. If the infection is left untreated, it spreads and destroys the tissue. Bacterial infection of the chronic skin lesions (“superinfection“) can lead to an unbearable odor. The ulcers can become huge, lead to lymphatic congestion and connective tissue hardening, and literally “eat away” at the genitals. In about 0.25% of patients, a cancerous ulcer develops at the appropriate site. The infection can rarely also spread into the body and lead, for example, to a bone infection or life-threatening blood poisoning.

Detection and therapy

Symptoms are quite easy for experienced physicians to detect in affected regions. Laboratory diagnosis is made by microscopic detection of the pathogen in a smear or tissue sample. Treatment is with antibiotics at least until complete healing – for 3-12 weeks, depending on the type of antibiotic. Sexual partners with contact within the last 40 days before the onset of symptoms should be examined and treated if necessary. Sexual intercourse should be avoided until complete healing has occurred. Despite adequate therapy, relapse may occur up to 18 months later. Smaller skin lesions heal completely, larger ones leave scars.

To the point

  • Donovanosis is a venereal disease occurring certain regions.
  • Infection occurs through contact with the ulcers.
  • The first sign is small, painless ulcers.
  • A complete cure with antibiotics is possible, without therapy, there may be pronounced mutilation.
  • The sexual partners should be treated if necessary.