Makindo Medical Notes

Related Subjects: |Treponema |Bejel (Endemic syphilis) |Pinta |Yaws (Frambesia) |Syphilis |Non gonococcal urethritis |Gonococcal urethritis |Lymphogranuloma Venereum (LGV) |Chancroid |Donovanosis

Donovanosis is a rare but important sexually transmitted infection (STI) that causes chronic, destructive ulcers. 🌍 It is endemic in parts of India, Papua New Guinea, central Australia, the Caribbean, and southern Africa. Early recognition and treatment are essential to prevent complications such as scarring and genital destruction.

📖 About

• Sexually transmitted infection causing chronic ulceration of skin and mucosa.
• Often misdiagnosed due to similarity with syphilis, chancroid, and cancer.
• Slowly progressive disease, sometimes called "granuloma inguinale."

🦠 Aetiology

• Caused by Calymmatobacterium granulomatis, now classified as Klebsiella granulomatis.
• Gram-negative, intracellular bacillus that forms characteristic “Donovan bodies.”
• Spread through sexual contact; incubation period 1–12 weeks.

🩺 Clinical Features

• The first sign is a firm papule or subcutaneous nodule → breaks down into an ulcer.
• Four classical clinical types:
  • 🔴 Ulcerogranulomatous: Beefy-red, fleshy, painless ulcers that bleed easily.
  • 🌰 Hypertrophic (verrucous): Raised irregular edge, “walnut-like” appearance.
  • 🦠 Necrotic: Foul-smelling, deep ulcers with extensive tissue destruction.
  • ⚪ Sclerotic (cicatricial): Extensive fibrosis and scarring, may cause strictures.
• 90% involve genitals; 10% inguinal region. Rare extragenital (oral, pharyngeal, bone, liver).
• Pregnancy: lesions enlarge more rapidly and risk of dissemination increases.
• SCC (squamous cell carcinoma) can arise in chronic lesions → biopsy if poor response to therapy.

🔍 Investigations

• Giemsa / Wright’s stain: Shows “Donovan bodies” — intracellular Gram-negative rods inside mononuclear cells.
• Histology: Chronic granulomatous inflammation with plasma cells and polymorphs.
• PCR / NAAT: Sensitive but not widely available.
• Culture: Rarely performed, only in specialised labs.
• Serology: Historical but unreliable.

💊 Management

• First-line: Azithromycin 1 g weekly or 500 mg daily PO until lesions heal (minimum 3 weeks).
• Alternatives:
  • Co-trimoxazole 160/800 mg BD PO.
  • Doxycycline 100 mg BD PO.
  • Erythromycin 500 mg QDS PO (preferred in pregnancy 🤰).
  • Gentamicin 1 mg/kg 8-hourly IV/IM (as adjunct in slow responders).
• Pregnancy: Erythromycin or Azithromycin.
• Children: Azithromycin 20 mg/kg daily PO.
• Neonatal prophylaxis: Azithromycin 20 mg/kg daily × 3 days if mother has active lesions.
• Partner management: All sexual partners in last 6 months should be examined, as asymptomatic incubation is long and no screening test exists.

⚠️ Complications

• Chronic scarring → strictures (urethral, vaginal, anal).
• Superimposed secondary infections.
• Genital destruction and mutilation in advanced disease.
• Squamous cell carcinoma risk in long-standing lesions.

📚 References

• 2018 UK guideline – Donovanosis
• WHO & CDC STI treatment guidelines.