KAYACHIKITSA SYLLAUS, PAPER 2, PART B

1. GRANULOMA INGUINALE
(Donovanosis)
Prof Sriram Chandra Mishra
Kayachikitsa Department
VYDS Ayurved Mahavidyalaya, Khurja

2. Definition
Granuloma inguinale is a sexual transmitted disorder caused
by the bacteria Klebsiella granulomatis characterised by progressive
ulcerative granulations on the genital regions.
It is also called Donovanosis because Donovan bodies are
present in the scraping from the edge of the lesions.
Formerly known as
• Calymmatobacterium granulomatis
• Donovania granulomatis

3. • Agent - Klebsiella granulomatis (Gram-negative bacterium)
• Incubation period - 8 days to 12 weeks
• Transmission
 Primarily through sexual contact
 Also be spread by contact with human faeces
• Epidemiology
 It is endemic in some tropical and developing areas, including India;
Papua, New Guinea; the Caribbean; central Australia; and southern
Africa
 In india it is endemic along the east coast i.e. Odisha, Andhra,
Tamilnadu.

4. Clinical features
• The disease has a painless, slowly progressive onset.
• Beginning with aninconspicuous (not visible) pimple or lumpy
eruption on the skin of genital region.
• Sore in the mouth or anal area according to exposure.
• May not notice the sore due to painless and small size.
• In some women the first symptom is bleeding from the genitals.
(Aninconspicuous - not visible)

5. Lesions larger than
in most other diseases
The edges of the ulcers are marked by granulation tissue.

6. The initial pimple or sore is typically followed by three stages of diseas
e.
1. First stage - The patient develops a mass
of pink or dull red granulation tissue in the area around the anus and bleeds.
(granulation tissue - rough or irregular surface and a rich supply of blood )
2. Second stage - The bacteria erode the skin to form shallow, foul
smelling ulcers which spread from the genital and anal areas to the
thighs and lower abdomen. The edges
of the ulcers are marked by granulation tissue.
3. Third stage - The ulcerated areas form deep masses of keloid (scar)
tissue that may spread slowly for many years.
(keloid An unusual or abnormal growth of scar tissue)

7. Complications
• Extra genital infection can occur with extension of infection to the
pelvis or it can disseminate to intra-abdominal organs, bones or the
mouth.
• Super infected ulcers become painful to touch, filled
with pus and dead tissue.
• The scar tissue produced by third
stage infection can grow until it closes off parts of
the patient's urinary tract.
• It is also associated with a higher risk of genital cancer and can
coexist with other sexually transmitted pathogens.

8. Investigations
Tissue smear - Finding Donovan bodies (skin tissue).
Donovan bodies are oval rod shaped organisms that appear inside infected tissue cells.
Clusters of blue or black staining, bipolar chromatin condensations in large mononuclear cells in
granulation tissue infected with Calymmato bacterium granulomatis.

9. Management
• Oral antibiotics for at least 3 weeks or until all lesions have completely
healed
• Azithromycin 1 g orally once per week or 500 mg daily OR
• Doxycycline 100 mg orally twice a day OR
• Ciprofloxacin 750 mg orally twice a day OR
• Erythromycin base 500 mg orally four times a day OR
• 12 weeks of treatment with ampicillin
• The addition of another antibiotic to these regimens can be considered if
improvement is not evident within the first few days of therapy. (aminoglycoside -
Gentamicin 1 mg/kg IV every 8 hours).
• All persons who receive a diagnosis of granuloma inguinale should be tested
for HIV.

10. Management of Sex Partners
Persons who have had sexual contact with a patient who has
granuloma inguinale within the 60 days before onset of the patient’s
symptoms should be examined and offered therapy.
Prognosis
• Treatment has been shown to halt progression of lesions.
• The skin ulcers will start to show signs of healing in about a week
• Healing typically proceeds inward from the ulcer margins
• Prolonged therapy is usually required to permit granulation and
re-epithelialization of the ulcers.
• Relapse can occur 6–18 months after apparently effective

11. Herpes Syphilis Chancroid
Lymphogranulo
ma Venereum
Granuloma
Inguinale
Appearanc
e
Often purulent "Clean" Purulent May be purulent "Beefy,"
hemorrhagic
Number Usually multiple Single Often multiple Single or multiple Multiple
Pain Yes No Yes Ulcer: no
Nodes: yes
No
Preceded by Papule, then
vesicle
Papule Papule Papule; ulcer often
unnoticed
Nodule(s)
Adenopathy Painful with
primary outbreak
Painless Painful; may
suppurate
Painful; may
suppurate
No, unless
secondary
bacterial infection
Systemic
symptoms
Often with
primary outbreak
Usually not Occasionally Usually not No
DIFFERENTIAL DIAGNOSIS