Granuloma inguinale

Alternative names:

donovanosis

Definition:

In the United States granuloma inguinale is a rarely encountered sexually-transmitted disease that results in surface destruction and granuloma formation in the skin and subcutaneous tissue.

Causes, incidence, and risk factors:

Granuloma inguinale is a bacterial disease caused by the organism Calymmatobacterium granulomatis. The disease is commonly found (endemic) in the tropical and subtropical areas of the world such as Southeast India, Guyana, and New Guinea; but occurs on occasion in the United States, typically in the Southeast. There are approximately 100 cases reported per year in the United States.

Men are more often affected than women, with a ratio of 2.5 to 1. Peak incidence occurs between 20 and 40 years old. 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. Fifty percent of the infected men and women have lesions in the anal area also.

The disease begins as a small papule on the genitalia that gradually eats away (erodes) the skin and forms an elevated beefy red velvety nodule (granulation tissue). The granulations are usually painless and bleed easily if traumatized. They grow by slow extension to areas of adjacent skin, gradually destroying the tissue as they enlarge. The growths frequently extend into the inguinal folds (where the legs meet the torso). Untreated disease results in mutilation and destruction of the genital tissue.

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.