Granuloma inguinale is a sexually transmitted infection caused by the bacteria Klebsiella granulomatis. It leads to chronic inflammation and scarring of the genitals.
Granuloma inguinale typically causes a painless, red lump on or near the genitals, which slowly enlarges, then breaks down to form a sore.
Doctors confirm the diagnosis by examining a sample of fluid from a sore.
Treatment with antibiotics is usually effective.
Using condoms during sex can help prevent passing granuloma inguinale and other sexually transmitted infections (STIs) from one person to another.
(See also Overview of Sexually Transmitted Infections.)
Granuloma inguinale is extremely rare in high-resource countries but occurs in India, southern Africa, and parts of South America.
Symptoms of Granuloma Inguinale
Symptoms of granuloma inguinale usually begin 1 to 12 weeks after infection. The first symptom is a painless, red bump (nodule) that slowly enlarges into a round, raised lump. The lump then breaks down to form a foul-smelling sore (ulcer) near the site of the initial infection:
Penis, scrotum, groin, and thighs in men
Vulva, vagina, and surrounding skin in women
Face
Anus and buttocks in people who have anal intercourse
CDC/ Joe Miller, Dr. Cornelio Arevalo, Venezuela
CDC/ Susan Lindsley
The sores slowly enlarge and spread to nearby tissue, causing further damage. Sores may also spread when they come into contact with other areas of the body. Without treatment, the sores continue to spread.
Sores heal slowly and may result in permanent scarring.
Occasionally the infection spreads through the bloodstream to the bones, joints, or liver. The infection may be fatal without treatment.
Diagnosis of Granuloma Inguinale
Examination of fluid from a sore
Granuloma inguinale is suspected in people who live in areas where the infection is more common and who have sores typical of the infection.
To confirm the diagnosis of granuloma inguinale, doctors take a sample of fluid from a sore and examine it under a microscope.
If the diagnosis is unclear, doctors remove a sample of tissue and examine it under a microscope (biopsy).
Treatment of Granuloma Inguinale
An antibiotic
Simultaneous testing and treatment of sex partners
Treatment is with the antibiotic azithromycin taken by mouth for at least 3 weeks. Treatment is continued until all sores are completely healed.Treatment is with the antibiotic azithromycin taken by mouth for at least 3 weeks. Treatment is continued until all sores are completely healed.
The antibiotics trimethoprim/sulfamethoxazole, doxycycline, and erythromycin are alternative treatments that are taken by mouth. Sometimes antibiotics are given by injection into a muscle or vein.The antibiotics trimethoprim/sulfamethoxazole, doxycycline, and erythromycin are alternative treatments that are taken by mouth. Sometimes antibiotics are given by injection into a muscle or vein.
When treated, people usually begin to improve within 7 days. Healing may be slow, and sores may return. In this case, treatment is required for a longer time. After treatment seems successful, people should be checked periodically for 6 months.
All sex partners who have had sexual contact with infected people in the past 60 days should be examined and, if infected, treated.
Prevention of Granuloma Inguinale
People can do the following to help reduce their risk of granuloma inguinale and other STIs:
Practice safer sex, including using a condom every time for oral, anal, or genital sex.
Reduce the number of sex partners and not have high-risk sex partners (people with many sex partners or who do not practice safer sex).
Practice mutual monogamy or abstinence.
Vaccinate (available for some STIs).
Seek prompt diagnosis and treatment to prevent spread to other people.
Identify sexual contacts if infected with an STI for the purposes of counseling and treatment.
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