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Granuloma inguinale - Causes, Symptoms, and Treatment

Definition

Granuloma inguinale is a sexually transmitted infection that affects the skin and mucous membranes of the anal and genital areas. Granulation tissue is tissue formed during wound healing that is rich in blood capillaries and has a rough or lumpy surface.
Granuloma inguinale is a relatively rare disease occurring in people living in tropical and subtropical areas. It occurs more frequently in males. In the United States, while homosexuals are at greater risk, it is relatively rare in heterosexual partners of those infected.

Causes

Granuloma inguinale, which is sometimes called donovanosis, is caused by Calymmatobacterium granulomatis, a rod-shaped bacterium formerly called Donovania granulomatis. The bacterium has an incubation period ranging from eight days to 12 weeks, with an average of two to four weeks.
Men are affected more than twice as often as women, with most infections occurring in people aged 20-40 years. The disease is seldom seen in children or the elderly.
It is thought that anal intercourse, rather than vaginal intercourse, is the most frequent source of infection. About 50% of infected men and women have lesions in the anal area.

Symptoms

The symptoms of granuloma inguinale usually appear within one week of infection, however, they can take as long as eighty days to manifest. First symptoms usually include :-
Upset stomach
Diarrhea
Rectal discomfort

The main symptom of granuloma inguinale is the appearance of small, red bumps on the genital area. These bumps are typically painless, and can form on the penis, vagina, labia, and rectum. Local lymph nodes may be enlarged and may become abscesses or ulcers as the infection spreads into the overlying skin.
In its early stages, it may be difficult to differentiate granuloma inguinale from chancroid. In the later stages, granuloma inguinale may resemble advanced genital cancers, lymphogranuloma venereum, and anogenital cutaneous amebiasis.

Treatment

Granuloma inguinale is treated with oral antibiotics. Three weeks of treatment with erythromycin, streptomycin, or tetracycline, or 12 weeks of treatment with ampicillin are standard forms of therapy. Although the skin ulcers will start to show signs of healing in about a week, the patient must take the full course of medication to minimize the possibility of relapse.
Trimethoprim-sulfamethoxazole and doxycycline are the antibiotics of choice. Alternatives include erythromycin, ciprofloxacin and azithromycin.
Response to treatment should begin within 7 days, but healing of extensive disease may be slow and lesions may recur, requiring more prolonged therapy. HIV-infected patients may also require prolonged or intensive treatment. Follow-up should continue for 6 month after apparently successful treatment. Sexual contacts should be examined.