Granuloma Inguinale

CDC Treatment Guidelines

This is a chronic, progressive, ulcerative, sexually-transmitted disease, involving the vulva, vagina or cervix.

The initial lesion is a papule which undergoes central necrosis to form a clean, granulomatous, sharply-defined ulcer. This process continues, with development of multiple, confluent ulcers, which may be painful or painless. The ulcers have a beefy red base which bleeds easily. Pseudobuboes in the groin can be felt.

The diagnosis is confirmed with biopsy of the ulcer, showing Donovan bodies on H&E stain or Giemsa stain.

This condition is rare in the United States, but somewhat more common in the tropical areas of southern Africa, India and New Guinea.

Treatment is

• Trimethoprim-sulfamethoxazole one double-strength tablet orally twice a day for a minimum of 3 weeks, or
• Doxycycline 100 mg orally twice a day for a minimum of 3 weeks, or
• Ciprofloxacin 750 mg orally twice a day for a minimum of 3 weeks, or
• Erythromycin base 500 mg orally four times a day for a minimum of 3 weeks, or
• Azithromycin 1 g orally once per week for a minimum of 3 weeks.

Therapy should be continued until all lesions have healed completely.

Prognosis is excellent when treated in its early stages. Delayed treatment is associated with extensive scarring of the vulva, rectum and groin.