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 orally once weekly (preferred) or

  • Doxycycline, 100 mg orally twice daily or

  • Ciprofloxacin, 750 mg orally twice daily or

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

  • Erythromycin, 500 mg orally four times daily

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