DONOVANOSIS
DONOVANOSIS ICD-10: A58
• STI caused by Klebsiella granulomatis, an encapsulated intracellular gram-negative rod. Rare in industrialized nations. Endemic foci in tropical and subtropical environments.
CLINICAL MANIFESTATION
Painless, progressive, ulcerative lesions of anogenital areas. Highly vascular (i.e., a beefy red appearance) (Fig. 30-38) and bleed easily on contact. Spreads by continuity or by autoinoculation of approximated skin surfaces. Distribution. Males: Prepuce or glans, penile shaft, and scrotum. Females: Labia minora, mons veneris, and fourchette. Ulcerations then spread by direct extension or autoinoculation to inguinal and perineal skin. Extragenital lesions occur in mouth, lips, throat, face, GI tract, and bone. REGIONAL LYMPH NODES Not enlarged. Large subcutaneous nodule may mimic a lymph node, that is, pseudobubo. VARIANT TYPES Ulcerovegetative (Fig. 30-38); nodular; hypertrophic; sclerotic/cicatricial.
COMPLICATIONS Deep ulcerations, chronic cicatricial lesions, phimosis, lymphedema (elephantiasis of penis, scrotum, vulva), and exuberant epithelial proliferation that grossly resembles carcinoma.
DIFFERENTIAL DIAGNOSIS
Differential diagnosis in endemic areas, syphilitic chancre, chancroid, chronic herpetic ulcer, LGV, cutaneous tuberculosis, and invasive SCC.
DIAGNOSIS
Visualize Donovan bodies (rod-shaped organisms seen in cytoplasm of mononuclear phagocytes) in tissue samples or touch or crush preparation or in lesional biopsy specimen. Rule out other or concurrent cause of genital ulcer disease.
COURSE
Little tendency toward spontaneous healing. Heals with antibiotic treatment. Relapse may occur.
TREATMENT
All antibiotic treatments should be given for at least 3 weeks or until all lesions have healed.
RECOMMENDED REGIMEN Oral doxycycline twice daily. ALTERNATIVE REGIMEN Oral azithromycin 1 g once a week. Ciprofloxacin 750 mg twice daily. Erythromycin base 500 mg four times daily. Trimethoprim-sulfamethoxazole double strength tablet (160 mg/800 mg) twice daily.
FIGURE 30-38 • Donovanosis: ulcerovegetative type Extensive granulation tissue formation, ulceration, and scarring of the perineum, scrotum, and penis.