The venereal disease granuloma inguinale or donovanosis is most common in tropical countries. If treatment is started early, the infection is often completely curable.
What is granuloma inguinale?
Granuloma inguinale is one of the infectious sexually transmitted diseases (diseases transmitted through sexual intercourse). The name donovanosis is derived from the tropical physician Charles Donovan, who first described the disease in 1905. Although granuloma inguinale is found worldwide, it is more common in tropical and subtropical countries (such as Central and South America and Africa). Men are affected by granuloma inguinale about twice as often as women. Since donovanosis is not adequately treated in many cases, chronic courses are often seen. Typical symptoms in the presence of granuloma inguinale are ulcers that form on the genitals.
Causes
Donovanosis is caused by the bacterium Klebsiella granulomatis. Due to this fact, the bacterium is also called Donovan corpuscles. The bacterium is immobile and encapsulated. Transmission of the Klebsiella granulomatis bacterium can occur through direct skin contact; primarily, this occurs during sexual intercourse. Where the causative agent of donovanosis enters the skin, it causes a pustule, which is also called primary effect in medicine. Although the pustule of granulomas inguinale is usually painless at first, ulcers usually develop later. These are susceptible to infection with bacteria, which can cause a more extensive bacterial infection. As a result, donovanosis can then lead to pain. Very rarely, the bacteria responsible for granuloma inguinale can enter organs or joints through the blood and cause symptoms here.
Symptoms, complaints, and signs
Granuloma inguinale does not initially cause any clear symptoms. The first sign is visible skin changes. Usually, small, reddish nodules form at the site where the pathogens have penetrated the skin. These do not cause pain and disappear by themselves after a few days. Further ulcers develop around the skin defect. These are usually flesh-colored and appear punched out, but usually also do not cause any noticeable discomfort. Pain does not occur until a bacterial superinfection occurs. Granuloma inguinale usually occurs in the pubic area. In men it is usually localized on the penis, in women in the area of the labia minora. The skin lesion is often associated with swelling and begins to hurt as it progresses. The adjacent lymph nodes are also swollen and painful to the touch. The disease may cause accompanying symptoms such as fever, malaise, and nausea. In the case of superinfection, there is a risk of blood poisoning, which is initially manifested by the characteristic reddish streak leading away from the infected site and toward the heart. In rare cases, the pathogens reach other parts of the body and cause joint or bone pain, for example.
Diagnosis and course
Granuloma inguinale is usually diagnosed by detecting the bacterium Klebsiella granulomatis. This is possible, for example, with the aid of a smear or even a tissue sample of the affected tissue. If a corresponding sample under the microscope cannot clearly confirm the presence of Donovan’s corpuscles, the attending physician has the option of first preparing a cell culture, which is then examined for the presence of granuloma inguinale. It is also necessary to exclude other diseases as the cause of symptoms similar to those of Donovanosis, such as diseases caused by the herpes simplex virus type 2 or syphilis. If detected and treated early, donovanosis is usually positive and symptoms heal completely. However, if granuloma inguinale has already spread and has been present for a long time, it can cause scarring, a narrowed urethra, or even mutilation, among other symptoms.
Complications
As a rule, granuloma inguinale does not lead to any particular complications. It can be treated relatively well and easily if early treatment occurs.There is also no reduction in life expectancy or further discomfort. In most cases, granuloma inguinale leads to reddening of the skin areas or to the formation of small nodules on the affected regions. These skin areas are also affected by itching, which can be very unpleasant for the patient. Furthermore, severe pain occurs on the genitals, so that the patient’s sexual life is negatively affected by granuloma inguinale. Although there is little discomfort, it can have a very negative impact on the patient’s daily life and lead to general fatigue. Granuloma inguinale is usually treated with the help of antibiotics and can thus be controlled relatively well. No other complications occur. In rare and severe cases, scars may form. Likewise, it is not impossible that granuloma inguinale may not recur after treatment. If early treatment does not occur, a tumor may form on the skin and destroy that tissue.
When should you go to the doctor?
If changes occur in the intimate area immediately after unprotected sexual intercourse or intimate skin contact with another person, a doctor should be consulted. If there is itching, redness of the skin, a burning sensation or general discomfort, it is advisable to consult a doctor. If swelling, growths, ulcers or the formation of nodules in the genital area occur, a visit to the doctor should be made as soon as possible. If open sores develop on the external or internal genitalia as a result of the existing symptoms, medical attention is needed. Further germs and pathogens can enter the organism via the open skin areas. In severe cases, there is a risk of blood poisoning. Therefore, a control examination should be initiated in time in case of unusual changes or inflammations. If the existing complaints of the genital organs spread further or persist for several days, a doctor is needed. If the affected person suffers from increased stress or irritability due to the symptoms, a doctor is needed. If there are emotional and psychological problems, persistent emotions such as disgust or guilt, and a feeling of illness, a doctor should be consulted. If sexual dysfunction, discomfort during the sexual act, or decreased libido occurs, the individual should consult a physician.
Treatment and therapy
In the case of granuloma inguinale detected early, a successful component of therapy can often be the administration of antibiotics. On average, antibiotic treatment of donovanosis is given over a period of approximately 2 to 3 weeks. If the antibiotic therapy of granulomas inguinale proves successful, the healing of the involved skin areas usually begins after about one week. Frequently, healing of smaller nodules in the presence of donovanosis occurs without leaving scars on the affected skin areas. However, in the case of healed larger ulcers, scarring may occur. In individual cases, relapses may occur after healing has taken place; these are then usually countered with follow-up examinations. Doctors recommend refraining from sexual contact during the period of therapy. If granuloma inguinale is not treated early or not treated at all, destruction of the affected tissue can result. In extreme cases, if donovanosis is left untreated, a malignant skin cancer may form on the affected areas of skin.
Outlook and prognosis
If granuloma inguinale is detected and treated early, the patient can expect a favorable prognosis. In these cases, there is a good chance that the disease can be completely cured. The swellings and ulcers gradually disappear with the administration of medication until there is complete freedom from symptoms. The functionality of the genital organs and the urethra are subsequently restored. No long-term consequences or limitations are to be expected in these patients. If medical care is not sought or if the start of therapy is delayed, the disease may become chronic. As a result, the prognosis is worsened in these patients. There is a possibility that scars will form in the further course or that the urethra will be narrowed. This leads to secondary symptoms and discomfort during urination.In some patients, this can affect kidney function in the long term. In severe cases, mutilation of the genital area or urethra may occur. As a result, sexual dysfunction or reduced libido are to be expected. As a result, sufferers are usually diagnosed with psychological disorders that contribute to a deterioration in well-being as well as quality of life. In rare cases, granuloma inguinale leads to the development of skin cancer. If left untreated, the ulcers can mutate and become a threat to life.
Prevention
Because donovanosis is a sexually transmitted disease, it can be prevented primarily by practicing protected sex (using condoms). This is especially true in countries where the risk of infection is high, such as Papua New Guinea and Brazil. A chronic course of donovanosis can be prevented primarily with early, effective therapy for acute donovanosis.
Follow-up
In the case of granuloma inguinale, very few measures or options for aftercare are available to the affected person. In this regard, the patient is primarily dependent on complete treatment of the disease, and early treatment and detection of granuloma inguinale is especially important. If granuloma inguinale is detected and treated at an early stage, there are usually no further complications. A complete cure of this disease is possible. After the treatment, usually no further measures of aftercare are necessary. Granuloma inguinale is usually treated with the help of drugs, mainly antibiotics are used. The affected person should always take these according to the doctor’s instructions. Even when the granuloma inguinale heals, the antibiotics should still be taken until the end in order to treat the disease completely. If scarring has occurred, it may be possible to treat it with surgery as well. Since granuloma inguinale may recur even after it has healed, regular examinations are very useful. Examinations for cancer are also very useful in this regard, as tumors may form in the affected areas.
This is what you can do yourself
Patients with granuloma inguinale suffer on the one hand from the strong itching caused by the ulcers, and on the other hand from a feeling of shame in the face of the disease. First of all, it is particularly relevant to follow exactly the instructions for taking the prescribed medication, as well as to follow other advice given by the attending physician. In order not to endanger their general well-being, patients pay particular attention to the occurrence of any side effects and seek medical help immediately in such cases. To ensure that the acute symptoms subside quickly and do not worsen, it is crucial to resist the itching and not to scratch the ulcers in the genital area. Against this background, thorough personal hygiene as well as adapted intimate hygiene should be taken into account and discussed with the responsible physician. In this context, suitable undergarments can also help to prevent further aggravation of the unpleasant itching. During the recovery phase, patients therefore prefer clothing made of natural fibers and, at best, those for allergy sufferers, so as not to provoke further irritation. In general, it is beneficial for regeneration if patients with granuloma inguinale allow themselves plenty of rest during drug treatment and also do not overload themselves physically, for example during sports activities.
