56 - Donovanosis (Granuloma Inguinale)

Abstract

Donovanosis (granuloma inguinale) is a rare cause of genital ulceration that is close to global eradication. There is debate about the nomenclature of the causative organism: phylogenetic analysis confirms close similarities between Calymmatobacterium granulomatis and the genus Klebsiella, and a proposal has been made that the infective agent be reclassified as Klebsiella granulomatis comb nov. The condition has an unusual geographic distribution, with most reported cases coming from India, Papua New Guinea, South Africa, and Brazil. Ulcers may be quite large and sometimes affect the inguinal region. Systemic spread can occur, but is uncommon. Diagnosis is usually made by the detection of the characteristic Donovan bodies in monocytes on tissue smears or biopsy specimens stained by the Giemsa method. Azithromycin has emerged as the drug of choice and should be used if the diagnosis is confirmed or suspected. Doxycycline, ciprofloxacin, and ceftriaxone are also effective.