Granuloma inguinale: Information & Specialists

Granuloma inguinale is more common in tropical and subtropical countries. It is particularly prevalent in

• South Africa,
• Central and South America,
• the Caribbean,
• Southern India,
• Southeast Asia,
• Papua New Guinea, and
• Northern Australia

. In the U.S. and Europe, granuloma inguinale is rare. Most patients are travelers returning from a region where the disease is common. Exact incidence figures are not available for Germany.

Men are about twice as likely to develop granuloma inguinale as women. Those affected are usually between the ages of 20 and 40.

The causative agent of granuloma inguinale is the bacterium Klebsiella granulomatis, which is found only in humans. The disease was first described in 1905 by the tropical medicine specialist Charles Donovan. For this reason, the bacterium is also called Donovan bodies.

The pathogen is a Gram-negative rod-shaped bacterium belonging to the family Enterobacteriaceae. It is encapsulated and nonmotile. In addition, Klebsiella granulomatis is pleomorphic: the rods can be straight or curved and, occasionally, even roundish.

Infection with this bacterium usually occurs through close skin-to-skin contact during sexual intercourse. The disease is therefore classified as a sexually transmitted disease.

During unprotected vaginal and anal intercourse, there is direct contact with the characteristic ulcers in the genital area. The bacteria then enter the human body through tiny skin abrasions or the mucous membranes. Once inside, they trigger an inflammatory response in the body and cause the characteristic ulcers.

In rare cases, the bacterium can also be transmitted via the fingers.

The first symptoms appear a few days to twelve weeks after infection with the pathogen. Small, hard, light-red nodules or pustules form at the site of contact. They may itch but do not cause pain.

These pustules soon rupture and then develop into flesh-colored ulcers. These can spread to the surrounding skin areas. They can also penetrate deep into the tissue, where they cause severe scarring and disfigurement.

In some cases, other bacteria may colonize the ulcers. They can then become inflamed and also form painful abscesses.

In men, the pustules and ulcers usually appear

• on the shaft of the penis,
• in the lumbar region, or
• in the anal region

.

In women, symptoms usually appear on the inner side of the labia. Severe swelling often develops there as well. The lower back and anal region may also be affected.

If it occurs

• in the mouth,
• the throat, or
• on the face

, these areas may also be affected.

If left untreated, the causative bacterium can, in rare cases, spread throughout the human body via the bloodstream. The responsible pathogens can then reach

• the bones,
• the joints,
• the liver, or
• other organs

. This leads to the onset of additional symptoms, including

• recurrent fever,
• progressive anemia, or
• weight loss.

Granuloma inguinale is usually diagnosed through

• a physical examination and
• laboratory testing to identify the pathogen

. During the physical examination, granuloma inguinale can usually be easily identified based on its 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 collected material is then examined microscopically in the laboratory for the presence of the bacterium. If definitive detection is not possible, a cell culture may also be performed.

When making the diagnosis, it is important to rule out other conditions. The symptoms of granuloma inguinale are similar to those of, among other conditions,

• early syphilis,
• lymphogranuloma venereum,
• chancroid,
• a herpes simplex type 2 infection, or
• skin cancer.

Consistent antibiotic therapy is effective for granuloma inguinale © joyfotoliakid | AdobeStock

Granuloma inguinale is usually treated with a specific course of antibiotics. The antibiotics are designed to specifically target and kill the causative pathogens. Patients must take them daily for a period of about two to three weeks, sometimes longer.

Antibiotics used for this purpose include those containing the active ingredients

• cotrimoxazole,
• tetracycline,
• ciprofloxacin,
• doxycycline, or
• erythromycin.

To monitor the success of treatment and detect a possible recurrence early, follow-up examinations should be conducted after completion of therapy.

It is also important to assess the sexual partners of the affected individual. The focus should be on all persons with whom the affected individual had sexual intercourse within 40 days prior to the onset of granuloma inguinale. They should also be examined and, if necessary, treated as well.

Affected individuals must also abstain from sexual intercourse until the ulcers have completely healed.

The prognosis for granuloma inguinale is generally good. However, it depends on how early antibiotic therapy was started. When treatment begins early, granuloma inguinale typically has a favorable course.

The first signs of improvement usually appear about one week after the start of antibiotic therapy. Smaller ulcers then begin to heal without leaving scars. With larger ulcers, however, scarring may occur during the healing process.

In isolated cases, a relapse may 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 become chronic and spread throughout the body. This can lead to gradual tissue destruction, as well as a narrowed urethra and mutilation. Malignant skin cancerous ulcers are also possible. In some cases, individuals may die as a result of an untreated granuloma inguinale infection.