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For further information, see CMDT Part 33-28: Granuloma Inguinale

Key Features

  • A chronic, relapsing granulomatous anogenital infection caused by Klebsiella granulomatis (previously known as Calymmatobacterium granulomatis)

  • The incubation period is 8 days to 12 weeks

Clinical Findings

  • Onset is insidious

  • Lesions occur on the skin or mucous membranes of the genitalia or perineal area

  • Lesions are relatively painless, infiltrated nodules that soon slough

  • A shallow, sharply demarcated ulcer forms, with a beefy-red friable base of granulation tissue

  • The lesion spreads by contiguity

  • The advancing border has a characteristic rolled edge of granulation tissue

  • Superinfection with spirochete-fusiform organisms is common

  • The ulcer then becomes purulent, painful, foul smelling, and extremely difficult to treat

Diagnosis

  • Culture

Treatment

  • Recommended regimens

    • Azithromycin, 1 g once weekly orally (preferred) or

    • Doxycycline, 100 mg twice daily orally or

    • Ciprofloxacin, 750 mg twice daily orally or

    • Trimethoprim-sulfamethoxazole, 1 double-strength tablet orally twice daily or

    • Erythromycin, 500 mg four times daily orally

  • Treatment duration is 3 weeks or until all lesions have healed

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