Granuloma inguinale (donovanosis)

The venereal disease Granuloma inguinale or Donovanosis is especially common in tropical countries. If treatment is started early, the infection is often completely curable.

What is granuloma inguinale?

As a rule, the inguinal granuloma does not lead to particular complications. It can be treated relatively well and easily if treated early.
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Granuloma inguinale is one of the infectious sexually transmitted diseases (diseases that are transmitted through sexual intercourse). The name of Donovanosis goes back to the tropical doctor Charles Donovan, who first described the disease in 1905.

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Although the granuloma inguinale is widespread worldwide, it is more common in countries in the tropics and subtropics (e.g. in Central and South America or Africa). Inguinal granuloma affects men about twice as often as women.

Since donovanosis is not adequately treated in many cases, it is often chronic. Typical symptoms of granuloma inguinale are ulcers that form on the genitals.

causes

The donovanosis is caused by the bacterium Klebsiella granulomatis. Because of this, the bacterium is also known as a Donovan body. The bacterium is immobile and encapsulated.

The bacterium Klebsiella granulomatis can be transmitted through direct skin contact; especially this happens during intercourse. Where the pathogen causing donovanosis penetrates the skin, it causes pustules, which in medicine is also referred to as the primary effect. Although the pustule of the inguinal granuloma is usually painless at first, ulcers usually develop later.

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These are susceptible to infection by bacteria, which can lead to further bacterial infection. The donovanosis can then lead to pain. The bacteria responsible for granuloma inguinale can very rarely get into organs or joints via the blood and cause discomfort.

Symptoms, ailments & signs

The inguinal granuloma does not initially cause any clear symptoms. The first sign are the visible skin changes. Usually small, reddish nodules form at the point where the pathogens have penetrated the skin. These do not cause pain and resolve on their own after a few days. More ulcers will develop around the skin defect.

These are usually flesh-colored and appear punched out, but usually also do not cause any noticeable discomfort. Pain only occurs when there is a bacterial superinfection. Granuloma inguinale usually occurs in the pubic area. In men it is mostly located on the penis, in women in the area of ​​the inner labia. The skin change is often associated with swelling and begins to hurt as it progresses.

The neighboring lymph nodes are also swollen and painful to the touch. The disease can cause accompanying symptoms such as fever, malaise and nausea. In the case of a superinfection, there is a risk of blood poisoning, which is initially expressed by the characteristic reddish stripe that leads away from the infected area and towards the heart. In rare cases, the pathogens reach other parts of the body and cause joint or bone pain, for example.

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Diagnosis & course

Granuloma inguinale is usually diagnosed by detecting the bacterium Klebsiella granulomatis. This is possible, for example, with the help of a smear or a tissue sample of the affected tissue.

If a corresponding sample cannot clearly confirm the presence of Donovan bodies under the microscope, the attending physician has the option of first creating a cell culture, which is then examined for a present granuloma inguinale.

In addition, other diseases that cause symptoms that are similar to those of donovanosis must be excluded; these include, for example, diseases caused by the herpes simplex virus type 2 or syphilis.

If detected and treated early, donovanosis is usually positive and symptoms heal completely. However, if a granuloma inguinale has already spread and has been present for a long time, it can lead to scars, a narrowed urethra or even mutilation.

Complications

As a rule, the inguinal granuloma does not lead to particular complications. It can be treated relatively well and easily if treated early. There is also no reduction in life expectancy or further complaints. In most cases, the inguinal granuloma leads to reddening of the skin or to the formation of small nodules on the affected areas.

These areas of the skin are also affected by itching, which can be very uncomfortable for the patient. Furthermore, there is severe pain in the genitals, so that the sex life of the patient is negatively influenced by the granuloma inguinale. Although there are only a few complaints, they can have a very negative impact on the patient's everyday life and lead to general exhaustion.

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Granuloma inguinale is usually treated with the help of antibiotics and can thus be combated relatively well. There are no further complications. In rare and serious cases, scars can form. Likewise, it cannot be ruled out that the inguinal granuloma may not recur after the treatment. If early treatment is not used, a tumor can form on the skin and destroy the tissue.

When should you go to the doctor?

If changes in the genital area occur immediately after unprotected sexual intercourse or intimate skin contact with another person, a doctor should be consulted. In the event of itching, reddening of the skin, a burning sensation or general malaise, it is advisable to consult a doctor. If there is swelling, growths, ulcers or the formation of nodules in the genital area, a doctor should be visited as soon as possible.

If the existing symptoms develop open wounds on the external or internal genitals, medical help is required. Other germs and pathogens can enter the organism through the open skin areas. In severe cases there is a risk of blood poisoning. Therefore, a check-up should be initiated in good time in the event of unusual changes or inflammation.

If the existing symptoms of the genital organs spread or if they last for several days, a doctor is needed. If the person concerned suffers from increased stress or irritability due to the symptoms, a doctor is needed. If you have emotional or psychological problems, persistent emotions such as disgust or guilt, or if you feel sick, a doctor should be consulted. If there are sexual dysfunction, discomfort during the sexual act or a reduced libido, the person concerned should consult a doctor.

Doctors & therapists in your area

Treatment & Therapy

If granuloma inguinale is detected early, a successful therapy component can often be the administration of antibiotics. On average, the antibiotic treatment of donovanosis takes place over a period of approx. 2 to 3 weeks. If the antibiotic therapy of an inguinal granuloma proves to be successful, the healing of the skin areas involved usually begins after about a week.

Small nodules often heal in the presence of donovanosis without leaving scars on the affected areas of the skin. When larger ulcers have healed, however, scarring can occur. In individual cases, relapses can occur after healing has taken place; These are then usually met with follow-up examinations.

Doctors recommend avoiding sexual contact during the period of therapy. If a granuloma inguinale is not treated early or not treated at all, the affected tissue can be destroyed.In extreme cases, untreated donovanosis can cause a malignant skin cancer to develop on the affected areas of the skin.

Outlook & forecast

If the granuloma inguinale is recognized and treated early, the patient can expect a favorable prognosis. In these cases, there is a good chance that the condition can be completely cured.

The swellings and ulcers gradually recede through the administration of medicines until the symptoms are completely free. The functionality of the sexual organs and the urethra are then restored. No long-term effects or limitations are expected in these patients.

Without the use of medical care or if the start of therapy is delayed, the course of the disease can become chronic. This worsens the prognosis for these patients. There is a possibility that scars may develop or the urethra may become narrowed as it progresses.

This leads to sequelae and discomfort when urinating. In some patients, this can have a long-term effect on kidney function. In severe cases, genital or urethral mutilation can occur. As a result, sexual dysfunction or a decreased libido can be expected.

As a result, those affected are usually diagnosed with psychological disorders that contribute to a deterioration in well-being and quality of life. In rare cases, the granuloma inguinale leads to the development of skin cancer. If left untreated, the ulcers can mutate and become life threatening.

prevention

Since donovanosis is a sexually transmitted disease, it can be prevented primarily by practicing protected sex (with the help of condoms). This is especially true in countries where there is a high risk of infection; these countries include Papua New Guinea and Brazil. A chronic course of donovanosis can be prevented above all with early, effective therapy of acute donovanosis.

Aftercare

In the case of granuloma inguinale, the person affected has very few measures or options for follow-up care. The patient is primarily dependent on a complete treatment of the disease, with early treatment and detection of the inguinal granuloma being very important. If the granuloma inguinale is recognized and treated early, there are usually no further complications. A complete cure of this disease is possible.

After the treatment, no further follow-up measures are usually necessary. The granuloma inguinale is usually treated with the help of medication, primarily antibiotics. The person concerned should always take this as directed by a doctor. Even when the granuloma inguinale heals, the antibiotics should still be taken until the end in order to treat the disease completely.

If there are any scars, they may also be treated with a surgical procedure. Since the granuloma inguinale can recur even after the inguinal granuloma has healed, regular examinations are very useful. Tests for cancer are also very useful, as tumors can develop in the affected areas.

You can do that yourself

Patients with granuloma inguinale suffer on the one hand from the severe itching caused by the ulcers and on the other hand from a feeling of shame in the face of the disease. First of all, it is particularly relevant to strictly adhere to the instructions for taking the prescribed medication and to follow further advice from the attending physician. In order not to endanger their general well-being, patients pay particular attention to the occurrence of possible side effects and seek medical help immediately in such cases.

In order for the acute symptoms to subside quickly and not worsen, it is crucial to resist the itching and not scratch the ulcers in the genital area. Against this background, thorough personal hygiene and adapted intimate hygiene must be taken into account, which must be discussed with the responsible doctor.

In this context, suitable underwear can also help prevent the unpleasant itching from becoming worse. Patients therefore prefer clothing made of natural fibers during the recovery phase and ideally those for allergy sufferers in order not to provoke further irritation. In general, it is beneficial for regeneration if the patients with granuloma inguinale allow themselves a lot of rest during the drug treatment and do not overload themselves physically, for example during sporting activities.