Granuloma Inguinale

Granuloma Inguinale is a topic covered in the 5-Minute Clinical Consult.

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Basics

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

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