Granuloma Inguinale

Description

Granuloma inguinale is a primarily sexually transmitted, chronic bacterial infection caused by Klebsiella granulomatis (formerly Calymmatobacterium granulomatis or Donovania granulomatis), an intracellular gram-negative bacillus (1):

• Causative organism similar to Klebsiella spp., leading to discussions on nomenclature
• Usually manifests as genital or anal lesions
• Sexual/anal intercourse is the main source.
• Also can be acquired via fecal route, passage through an infected birth canal, or contact with bare laps of infected individuals (children)
• Granuloma inguinale is a risk factor for acquiring HIV infection.
• Four varieties of skin lesions exist: ulcerovegetative, cicatricial, nodular, and verrucous
• Synonym(s): donovanosis

Epidemiology

• <100 cases annually in the United States (mostly foreign travel)
• Endemic: tropical and subtropical regions (e.g., New Guinea, Caribbean, West Indies, Southern India, sub-Saharan Africa, Southeast Asia, Australia, Brazil)
• Incidence higher in blacks in the United States
• Predominant sex: Males are slightly more susceptible.
• Predominant age: 20 to 40 years; rarely seen in children or elderly; no congenital cases reported

Etiology and Pathophysiology

• Repeated exposure is necessary for clinical infection to occur.
• Communicable as long as the infected person remains untreated and bacteria are present
• Bacterial infection caused by the bacillus K. granulomatis/C. granulomatis (previously known as D. granulomatis)

Risk Factors

• Residing or traveling in underdeveloped parts of tropical/subtropical countries
• Sexual contact with travelers to endemic area
• Males having unprotected sex with males
• Anal intercourse
• Low socioeconomic background
• HIV positivity

General Prevention

• Safe sex practices
• If infection likely, avoid sexual contact; notify partners.
• Examples of prevention include barrier methods of contraception, avoidance of high-risk sexual activity, and appropriate gynecologic screening (including during the course of pregnancy).
• Sexual contacts within 60 days prior to symptom onset should be evaluated and offered treatment.
• Remaining up to date on HIV care

Commonly Associated Conditions

Can be associated with other STIs, including HIV infection