Granuloma inguinale occurs more frequently in tropical and subtropical countries . It is particularly common in
- South Africa,
- Central and South America,
- the Caribbean,
- South India,
- Southeast Asia,
- Papua New Guinea and
- northern Australia
is widespread. In the USA and Europe, granuloma inguinale occurs only rarely. Most patients are travelers returning from an area where the disease is common. Exact disease figures are not available for Germany.
Men contract granuloma inguinale about twice as often as women. Those affected are usually between 20 and 40 years old.
The causative agent of granuloma inguinale is the bacterium Klebsiella granulomatis, which only occurs in humans. The disease was first described in 1905 by the tropical physician Charles Donovan. This is why the bacterium is also known as Donovan's corpuscles.
The pathogen is a gram-negative rod bacterium from the Enterobacteriaceae family. It is encapsulated and immobile. In addition, Klebsiella granulomatis is multiform (pleomorphic): The rods can therefore be straight or curved and occasionally roundish.
Infection with this bacterium usually occurs through close skin contact during sexual intercourse. The disease is therefore classified as a sexually transmitted disease.
Unprotected vaginal and anal intercourse leads to direct contact with the typical ulcers in the genital area. The bacteria then penetrate the human tissue via the smallest skin lesions or the mucous membrane. There they trigger an inflammatory reaction in the body and cause the characteristic ulcers.
In rare cases, the bacteria can also be transmitted through the fingers.
The first symptoms appear a few days to twelve weeks after infection with the pathogen. Small, hard, bright red nodules or pustules form at the site of contact. They may itch, but do not cause any pain.
These pustules soon disintegrate and then turn into flesh-colored ulcers. These can spread to the surrounding areas of skin. They can also reach deep into the tissue. There they cause pronounced scars and mutilations.
Other bacteria may colonize the ulcers. They can then become inflamed and also form painful abscesses.
In men, the pustules and ulcers usually occur
- on the shaft of the penis,
- in the lumbar region or
- in the anal region
region.
In women, the symptoms usually appear on the inside of the labia. A massive swelling also often forms there. The loins and anal region can also be affected.
If it occurs
- in the mouth,
- on the neck or
- the face
these areas can also be affected.
If left untreated, the causative bacterium can, in rare cases, spread through the bloodstream in the human body. The responsible pathogens can then enter
- the bones,
- the joints,
- the liver or
- other organs
organs. Further symptoms then occur, including
- recurring fever,
- progressive anaemia or weight loss.
- weight loss.
Granuloma inguinale is usually diagnosed by
- a physical examination and
- a laboratory test for the pathogen
in the laboratory. During the physical examination, granuloma inguinale can usually be easily recognized by the typical symptoms.
A tissue sample is required for direct detection of the causative pathogen Klebsiella granulomatis. To do this, the doctor takes a swab from the pustules or ulcers in the genital area.
The material taken is then examined microscopically for the bacterium in the laboratory. If there is no clear evidence, a cell culture can also be taken.
When making a diagnosis, it is important to rule out other diseases. The symptoms of granuloma inguinale are similar to those of
Consistent antibiotic therapy helps with granuloma inguinale © joyfotoliakid | AdobeStock
Granuloma inguinale is usually treated as part of a special antibiotic therapy. The antibiotics are intended to specifically kill the causative pathogens. Those affected must take them daily over a period of around two to three weeks, sometimes even longer.
The antibiotics used include those with the active ingredients
- Cotrimoxazole,
- tetracycline,
- ciprofoxacin,
- doxycycline or
- erythromycin.
To monitor the success of treatment and detect possible recurrences at an early stage, further follow-up examinations should take place after treatment has been completed.
It is also important to look at the sexual partners of the person affected. The focus is on all persons with whom the affected person had sexual intercourse within 40 days prior to the outbreak of granuloma inguinale. They should also be examined and treated if necessary.
Those affected must also refrain from sexual intercourse until the ulcers have completely healed.
The prognosis for granuloma inguinale is generally good. However, they depend on how early antibiotic therapy was started. If therapy is started early, granuloma inguinale usually takes a positive course.
The first successes are usually seen around one week after starting antibiotic therapy. Smaller ulcers then begin to heal without leaving scars. In the case of larger ulcers, however, scarring may occur during healing.
In individual cases, a relapse can occur up to 18 months after the initial infection despite adequate treatment. Regular follow-up examinations are therefore advisable.
If left untreated, granuloma inguinale can take a chronic course and spread throughout the human body. This can lead to gradual destruction of the tissue as well as a narrowed urethra and mutilation. Malignant skin tumors are also possible. Sometimes those affected die as a result of an untreated infection with granuloma inguinale.
