Background

This is a rare disease in Western countries but is endemic in many developing countries. The lesions manifest as papules, nodules, and ulcers. Occasionally, there are necrotic and sclerotic lesions. This is a sexually transmitted disease. In men, the prepuce and coronal sulcus may be affected while in women, the labia majora, vagina, and cervix are affected.

OUTLINE

Epidemiology
Disease Associations
Pathogenesis
Laboratory/Radiologic/ Other Diagnostic Testing
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Special Stains/ Immunohistochemistry/ Electron Microscopy
Differential Diagnosis
Prognosis
Treatment
Commonly Used Terms
Internet Links

EPIDEMIOLOGY	CHARACTERIZATION
SYNONYMS	Donovanosis
GEOGRAPHY	Tropical and subtropical zones South Africa Durban and Kwazulu Natal region
The dark side to Donovanosis: color, climate, race and racism in American South venereology. Hammar L.	J Med Humanit. 1997 Spring;18(1):29-57. Abstract quote   Medical experimentation on humans with "classic" sexually transmitted diseases (e.g., syphilis, gonorrhea) is not generally well known, but experimentation with others such as Granuloma inguinale, or Donovanosis, is even less so. Endemic to non-existent here, hyper-epidemic there, between 1880 and 1950 Donovanosis was linguistically and morally "constructed" as a disease of poor, sexually profligate, tropical, darkly-skinned persons. It was also experimentally produced on and in African-American patients in many charity hospitals in the American South. This essay analyzes Donovanosis literature of the period that heavily featured skin color, climate and tropicality, venereal sin, and racial susceptibility. It then recounts the history of human experimentation with it, and explains both its linguistic construction and its biomedical experimental history in terms of "disease narratives" produced not only by but for venereologists.

 

DISEASE ASSOCIATIONS	CHARACTERIZATION
SEXUALLY TRANSMITTED DISEASES

 

PATHOGENESIS	CHARACTERIZATION
Calymmatobacterium granulomatosis	Gram negative bacillus
Cycle	Exposure of traumatized skin of genitalia to bacillus leads to colonization and infection with incubation of several days to months

 

GROSS APPEARANCE/ CLINICAL VARIANTS	CHARACTERIZATION
Donovanosis. O'Farrell N.	Sex Transm Infect. 2002 Dec;78(6):452-7. Abstract quote   Donovanosis, a chronic cause of genital ulceration, has recently been the subject of renewed interest after a long period of relative obscurity. The causative organism, Calymmatobacterium granulomatis, has been cultured for the first time in many years and a polymerase chain reaction diagnostic using a colorimetric detection system has been developed. Phylogenetic analysis confirms close similarities with the genus Klebsiella and a proposal made that C granulomatis be reclassified as Klebsiella granulomatis comb nov. Azithromycin has emerged as the drug of choice and should be used if the diagnosis is confirmed or suspected. In donovanosis endemic areas, syndromic management protocols for genital ulceration may need to be adapted locally. A significant donovanosis epidemic was reported in Durban from 1988-97 but the current status of this epidemic is unclear. The donovanosis elimination programme among Aboriginals in Australia appears successful and is a model that could be adopted in other donovanosis endemic areas. Overall, the incidence of donovanosis seems to be decreasing. Increased attention would undoubtedly be paid to donovanosis if policy makers recognised more readily the importance of genital ulcers in fuelling the HIV epidemic.
MAIN CLINICAL VARIANTS
Ulcerovegatative	Most common Papules and small nodules that erode to form painful ulcers Ulcers have sharp borders with clean base formed by granulation tissue
Nodular	Soft erythematous nodules resembling granulation tissue
Hypertrophic	Large vegetating soft masses
Cicatricial	Expanding scarring plaques
VARIANTS
Phagedenic ulceration
Genital mutilation and amputation
Dermal fibrosis with lymphatic obstruction
Genital elephantiasis
OSTEOMYELITIS
Disseminated donovanosis (granuloma inguinale) with osteomyelitis of both wrists. Fletcher HM, Rattray CA, Hanchard B, Vaughan K, West WM. Departments of Obstetris, Gynaecology and Child Health, Pathology and Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston 7, Jamaica, West Indies.	West Indian Med J. 2002 Sep;51(3):194-6. Abstract quote   Donovanosis is a sexually transmitted infection which presents with genital ulceration and inguinal lymphadenopathy. Rarely, it presents with extra-genital manifestations. We present a case of disseminated donovanosis with cervical ulceration, massive pelvic lymphadenopathy, osteomyelitis of the wrists and septic arthritis of the knees and right elbow. A 23-year-old gravida two presented with wasting, oedema, ascites, bilateral iliac lymphadenopathy, anaemia and a large ulcer of the cervix uteri. Two months later in the outpatient clinic, she was much improved but still had post-coital bleeding and a hyperaemic cervix, suggestive of persistent infection. The course of antibiotics was therefore repeated. Histopathological examination of a specimen from colposcopic biopsy of the cervix uteri revealed granuloma inguinale. She improved after several courses of antibiotics, blood transfusion, surgical debridement and aspiration of affected joints.

 

HISTOLOGICAL TYPES	CHARACTERIZATION
General	Ulceration with pseudoepitheliomatous hyperplasia Microabscesses with plasma cells and histiocytes, many showing foamy cytoplasm
Donovan bodies	Vacuolated organisms within the histiocytes Extra and intrahistiocytic Donovan bodies
VARIANTS
Transepidermal elimination of cutaneous vulvar disease	J Cutan Pathol 2000;27:493-499.

 

SPECIAL STAINS/ IMMUNOPEROXIDASE	CHARACTERIZATION
Special stains	Warthin-Starry and Giemsa stains positive in Donovan bodies

PROGNOSIS AND TREATMENT	CHARACTERIZATION
TREATMENT	Azithromycin

Int J Dermatol 1992;31:244-246
Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.

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Last Updated June 16, 2005

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