Granuloma Inguinale (GI) is a sexually transmitted disease (STD) that is caused by the gram-negative pleomorphic bacillus Klebsiella granulomatis. The disease is also known as Donovanosis, which is named after Donovan Bodies, intracellular inclusions that are used as a diagnostic sign to identify Granuloma Inguinale.
Granuloma Inguinale affects the skin, mucuous membranes and lymphatic system of the genitalia and anal area. It is primarily transmitted through vaginal, oral and/or anal intercourse, but there have been known cases that prove GI was transmitted through the fecal route or via birth canal during labor.
Open sores are responsible for the spread of the bacterial organisms during sexual contact. These sores are often painless and the reason why Granuloma Inguinale is often mistaken for Syphilis.
The areas that Granuloma Inguinale affects in men are: the penis, the scrotum and/or glans. In women, the areas that are affected in women are: labia minora, mons veneris, the fourchette, and sometimes the cervix.
History of Granuloma Inguinale
In 1882 Granuloma Inguinale was known as a serpiginous ulcer. In 1905 a doctor named Charles Donovan identified the micro-organisms that were responsible for Granuloma Inguinale. This is where the term “Donovan Bodies” comes from and why GI is also referred to as Donovania granulomatosis or Donovanosis.
Symptoms of Granuloma Inguinale
People that have been infected with Granuloma Inguinale usually experience symptoms approximately 10 to 40 days after exposure. Small red bumps appear and are often painless. These red bumps then burst and exude a fleshy and bacterial-infected substance. This causes the infection to spread, destroying the already infected tissue. Until GI is treated it will carry on destroying the tissue.
There are many visible symptoms of Granuloma Inguinale, and they include:
- Red, fleshy bumps
- Skin ulcers
- Red skin lesions
- Vaginal bleeding after intercourse
- Foul-smelling discharge
- Abnormal vaginal bleeding
- Patches of red tissue
- Genital blisters
Diagnosing Granuloma Inguinale
Granuloma can go undetected for years, so it is necessary to get tested if you are engaging in high risk sexual behaviors. The open sores and lesions that are associated with Granuloma Inguinale can be used to visually diagnose the disease.
In addition a procedure known as the Wright-Giemsa stain can be done to better evaluate the cells and confirm the existence of Donovan bodies, consequently verifying Donovonosis.
Treatment for Granuloma Inguinale
Granuloma Inguinale is treated with antibiotics. Either 3 weeks of erythromycin, streptomycin, or tetracycline is used; or 12 weeks of ampicillin treatment is administered. Symptoms will start to diminish within a week of taking the medication, but it is very important to finish the entire course of treatment so that re-infection does not occur.
Because these medications are readily available in the United States, Granuloma Inguinale is not a huge problem. However, in places like South Africa, the Caribbean, Southern India, Brazil, Western New Guinea, Southeast Asia and Australia, the disease is more prevalent. Any area where there are little or no medical facilities is susceptible to Granuloma Inguinale.
What Happens if Granuloma Inguinale Goes Untreated?
Granuloma Inguinale is quite dangerous if untreated. Firstly, the lesions and open sores can continue to spread if treatment is not obtained. Additionally, there are four more serious conditions that can evolve as a result of untreated Granuloma Inguinale.
Carcinoma is a serious complication that results from untreated Granuloma Inguinale. This condition occurs in less than 1 percent of patients. It includes both squamous and basal cell carcinoma. These are both different types of skin cancers. In women, squamous carcinoma can spread from the vagina to the lungs and liver. Basal cell carcinoma is the most common type of skin cancer, and can be treated based on the type, penetration, size and location of the cancer as well as the patient’s age and overall health.
The open sores and lesions associated with Granuloma Inguinale can heal, but can also lead to considerable deformities and disability of certain functions once healed. These deformities and disabilities are a result of extensive fibrosis, stricture formation, and/or phimosis that can occur after the lesions are healed.
Another consequence of untreated Granuloma Inguinale is elephantiasis of the genitals. Elephantiasis is the thickening of the skin and underlying tissues, causing body parts to swell in size. For example, in some men with elephantiasis, their scrotum swells to the size of a basketball.
In addition, Granuloma Inguinale can spread to other parts of the body from the genital area. It can be fatal if vital organs and systems are affected.
Preventing Granuloma Inguinale
The best way to avoid contracting Granuloma Inguinale is to not have sex. Since it is mildly contagious outside of sexual intercourse, abstinence is the one definite way to significantly lower the risk of getting GI. If sexual intercourse cannot be avoided, knowing your partner’s sexual history and sexual health is crucial. Furthermore, limiting sexual partners can reduce your risk of transmission and contraction.
Since the disease is prevalent in some regions and not others, it is important to not engage in high risk sexual behavior, or any sexual behavior, when in contact with people from that region. In addition, if traveling to these countries, abstaining from sexual contact or taking proper precautions can also greatly reduce your risk of contracting GI.
If you have been infected with Granuloma Inguinale, keep a close eye on the scar tissue and any other symptoms that may resurface. Completing antibiotic treatment will help any re-infection from developing.
Getting tested regularly for STDs and at the onset of any type of abnormal symptoms can decrease the risk of contracting Granuloma Inguinale. If the disease is caught early, antibiotics can be used to treat it and more serious complications can be prevented.
Who Is at Risk for Contracting Granuloma Inguinale?
The following list includes those people that are at a higher risk of contracting Granuloma Inguinale:
- People with new sexual partners
- People with more than 2 partners
- People not using any method of protection
- Individuals abusing drugs or alcohol before engaging in sexual intercourse
- People engaging in intercourse with people from high-risk countries
- People engaging in intercourse while traveling to high-risk countries
- People working in the sex trade
Statistics about Granuloma Inguinale
The following are some important statistics about Granuloma Inguinale:
- 272 new cases of Granuloma Inguinale occur every year in the United States
- The incidence is highest for people between the ages of 20 and 40
- 15 new cases of Granuloma Inguinale are reported in Australia each year
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