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AT-A-GLANCE

AT-A-GLANCE

  • Granuloma inguinale (GI) is a rare, chronic, progressive ulcerative disease that mainly affects the genital and perigenital skin.

  • GI is primarily contracted through sexual transmission.

  • GI is caused by infection with Klebsiella granulomatis, a gram-negative bacteria.

  • It affects mostly people of lower socioeconomic status living in tropical or subtropical areas.

  • Diagnosis confirmed by demonstrating intracellular Donovan bodies on histology.

INTRODUCTION

Granuloma inguinale (GI), or donovanosis, is a rare chronic ulcerative disease affecting mainly genital and perigenital skin. The microorganism was first identified in 1905 by Donovan, who noted the characteristic Donovan bodies in macrophages. In 1955, the name “donovanosis” was proposed.1 The prevalence of GI has decreased markedly in recent times, and it can now be considered a sporadic disease. Despite its rarity, GI can have an aggressive clinical course so prompt recognition and treatment are necessary.

EPIDEMIOLOGY

GI is typically found in warm, moderately humid tropical and subtropical climates. GI has characteristically been reported in specific endemic areas, including Papua New Guinea, South Africa, parts of India and Brazil, and among the Aboriginal community of Australia.2

Sporadic cases have been reported elsewhere in southern Africa, the West Indies, and South America.3 The disease is very rare in Europe and North America. Since 1989, fewer than 10 cases per year have been reported in the United States.4 Recent epidemiologic data is limited, but overall, the incidence of GI is decreasing, especially in previously endemic areas such as Papua New Guinea and Australia.3,5 The disease has nearly been eradicated from Australia, with only five cases reported in 2004.5 GI is most commonly seen in individuals with lower socioeconomic status and sexually active adults between ages 20 and 40 years. No true race or gender predilection has been determined.

MODE OF TRANSMISSION

Although the mode of transmission is generally thought to be sexual, this is controversial. The consensus that donovanosis is transmitted sexually has been predominant since the middle of the 20th century. The majority of cases of GI occur in patients who have a history of sexual activity, and there is an increased incidence of the disease in age groups with the highest sexual activity. Often individuals with GI have history of sexual contact with sex professionals and concurrent sexually transmitted infections (STIs).6 The predominance of genital lesions and lesions on the cervix only or on the anus in men involved with receptive anal intercourse all favor venereal origin. However, GI has occurred in young children and sexually inactive adults, challenging the idea that all cases are sexually transmitted. Furthermore, transmission rate between sexual partners is lower compared with other STIs.2 The incidence of GI is also relatively low among sex workers and their conjugal partners. In rare cases, transvaginal transmission of GI during delivery can occur....

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