Granuloma inguinale (donovanosis) is a chronic bacterial infection that causes progressive tissue destruction in the genital and groin areas and is primarily transmitted through sexual contact. This condition, which directly threatens urogenital health, has the potential to profoundly affect quality of life by causing structural deterioration on the skin surface. Cases that are initially neglected because they are mistaken for a simple skin problem may eventually develop into serious anatomical deformities that are extremely difficult to repair. From a urological perspective, detecting and controlling the condition at an early stage is a critical step both in preventing permanent damage and breaking the chain of infection transmission.<\/p>\n
| Definition<\/span><\/td>\n | Granuloma inguinale (Donovanosis) is a chronic sexually transmitted infection caused by the bacterium <\/span>Klebsiella granulomatis. It causes progressive ulcers in the genital area and may lead to serious tissue damage if left untreated.<\/span><\/td>\n<\/tr>\n| Causative Agent<\/span><\/td>\n | Klebsiella granulomatis (formerly known as <\/span>Calymmatobacterium granulomatis<\/span><\/i>)<\/span><\/td>\n<\/tr>\n | Route of Transmission<\/span><\/td>\n | It is most commonly transmitted through unprotected vaginal or anal sexual contact. Less commonly, it may be transmitted during oral sexual contact. Transmission through everyday social contact is not expected.<\/span><\/td>\n<\/tr>\n | Risk Factors<\/span><\/td>\n | Unprotected sexual intercourse, multiple sexual partners, travel to or residence in regions where the disease is prevalent, and the presence of other sexually transmitted infections.<\/span><\/td>\n<\/tr>\n | Incubation Period<\/span><\/td>\n | Usually <\/span>1\u201312 weeks, although longer periods may also be reported.<\/span><\/td>\n<\/tr>\n | Regions Where It Is Most Common<\/span><\/td>\n | Tropical and subtropical regions; certain parts of India, Papua New Guinea, South Africa, Brazil, and some Caribbean countries. It is now quite rare in many countries.<\/span><\/td>\n<\/tr>\n | Most Commonly Affected Areas<\/span><\/td>\n | Penis, vulva, vagina, cervix, perianal area, and groin region; rarely the mouth and other parts of the body.<\/span><\/td>\n<\/tr>\n | Symptoms<\/span><\/td>\n | Painless, slowly enlarging red nodules; fleshy-looking ulcers that bleed easily; foul-smelling discharge; and tissue loss and deformity in advanced cases. Pain generally occurs if a secondary bacterial infection develops.<\/span><\/td>\n<\/tr>\n | Physical Examination Findings<\/span><\/td>\n | Velvety, bright red ulcers that bleed easily; lesions in which granulation tissue is more prominent than induration; lymph nodes generally do not enlarge significantly, but pseudobuboes may develop.<\/span><\/td>\n<\/tr>\n | Disease Types<\/span><\/td>\n | Ulcerative (most common), hypertrophic\/verrucous, necrotic, and sclerotic (fibrotic) types.<\/span><\/td>\n<\/tr>\n | Diagnosis<\/span><\/td>\n | Clinical evaluation, demonstration of Donovan bodies in a sample taken from the lesion (microscopy), and biopsy. Culture is not routinely performed. Molecular tests may be used in some centers.<\/span><\/td>\n<\/tr>\n | Donovan Bodies<\/span><\/td>\n | These are characteristic structures seen inside macrophages that represent the bacterium and are an important diagnostic finding.<\/span><\/td>\n<\/tr>\n | Differential Diagnosis<\/span><\/td>\n | Syphilis, chancroid, lymphogranuloma venereum, genital herpes, squamous cell carcinoma, Beh\u00e7et’s disease, and other causes of genital ulcers.<\/span><\/td>\n<\/tr>\n | Treatment<\/span><\/td>\n | Long-term antibiotic treatment is administered. Commonly used options include azithromycin, doxycycline, erythromycin, or trimethoprim-sulfamethoxazole. Treatment is generally continued until all lesions have completely healed.<\/span><\/td>\n<\/tr>\n | Duration of Treatment<\/span><\/td>\n | In most patients, treatment is continued for at least <\/span>3 weeks or until the lesions have completely healed.<\/span><\/td>\n<\/tr>\n | Surgical Treatment<\/span><\/td>\n | It is generally not necessary. However, reconstructive surgery may be required in cases involving advanced tissue loss, scar tissue, or deformity.<\/span><\/td>\n<\/tr>\n | Treatment During Pregnancy<\/span><\/td>\n | The appropriate antibiotic is selected according to the pregnancy status. Medications to be used during pregnancy must be determined by a physician.<\/span><\/td>\n<\/tr>\n | Complications<\/span><\/td>\n | Tissue destruction, genital deformity, secondary bacterial infection, lymphedema, permanent scarring in the genital area, and chronic changes rarely associated with the development of genital cancer.<\/span><\/td>\n<\/tr>\n | Relationship with HIV<\/span><\/td>\n | Genital ulcers may increase the risk of HIV transmission. The disease may be more severe in HIV-positive individuals, and the duration of treatment may be prolonged.<\/span><\/td>\n<\/tr>\n | Sexual Partner Management<\/span><\/td>\n | Evaluation of sexual partners and examination when necessary are recommended. Partners who develop symptoms should be treated.<\/span><\/td>\n<\/tr>\n | Prevention Methods<\/span><\/td>\n | Condom use, monogamy, regular sexual health checkups, avoiding sexual contact in the presence of suspicious lesions, and early treatment.<\/span><\/td>\n<\/tr>\n | Recovery Process<\/span><\/td>\n | Complete recovery is possible with early diagnosis and appropriate antibiotic treatment. Permanent tissue damage may develop in delayed cases.<\/span><\/td>\n<\/tr>\n | Risk of Recurrence<\/span><\/td>\n | Because recurrence may occur after treatment, patients are advised to undergo follow-up at regular intervals.<\/span><\/td>\n<\/tr>\n | When Should a Doctor Be Consulted?<\/span><\/td>\n | A healthcare facility should be consulted without delay when there is a painless ulcer in the genital area, a wound that bleeds easily, a lesion that does not heal for a long time, or suspicion of a sexually transmitted infection.<\/span><\/td>\n<\/tr>\n | Prognosis<\/span><\/td>\n | The prognosis is generally good with early diagnosis and appropriate treatment. If left untreated, progressive tissue destruction and permanent complications may develop.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n | |