Granuloma venereum

Etiologic pattern of genital ulcers in Lusaka, Zambia: has chancroid been eliminated?

BACKGROUND

Genital ulcers are a public health problem in developing countries. The World Health Organization recommends the use of syndromic guidelines for sexually transmitted infection treatment in resource-constrained countries. Monitoring local etiologies provides information that may aid policy for sexually transmitted infection treatment. We investigated the etiology of genital ulcer disease among outpatients in Lusaka, Zambia.

METHODOLOGY

Swabs from genital ulcers of 200 patients were tested using polymerase chain reaction for Treponema pallidum, herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), Haemophilus ducreyi, and Chlamydia trachomatis.

RESULTS

The prevalence of the detected pathogens was as follows; HSV-2, 28%; T. pallidum, 11.5%; C. trachomatis, 3%; HSV-1, 0.5%; and H. ducreyi, 0%. Coinfection with HSV-2 and T. pallidum was 1.5%, and coinfection of HSV-2 and C. trachomatis was 1%. In 55% of the patients, no etiologic diagnosis could be established.

CONCLUSIONS

H. ducreyi was not detected, whereas HSV-2 and T. pallidum were the commonest pathogens. Nondetection of H. ducreyi requires further studies. If the present findings are validated, treatment guidelines would require to be revised in Zambia.

Computed tomography of lymphogranuloma venereum mimicking cervical cancer

A case of lymphogranuloma venereum involving the cervix as a primary site is discussed. The patient's clinical presentation and findings on tomography were suggestive of carcinoma of the cervix. The differential diagnosis of retroperitoneal pelvic lymphadenopathy is discussed.

Granuloma inguinale of the cervix: a carcinoma look-alike

Granuloma inguinale of the cervix presents as a proliferative growth and may mimic carcinoma. Over a 3 year period 18 patients with cervical granuloma inguinale were detected. Nine (50%) had a clinical diagnosis of carcinoma of the cervix on admission, five of whom had extensive investigations to exclude a malignancy. In communities where these two conditions are commonly seen it is recommended that granuloma inguinale be considered in young women with granulomatous lesions of the cervix, so as to avoid extensive and financially costly investigations, and unnecessary psychological stress for patients.

Extragenital donovanosis: three cases from Western Australia

Three unusual cases of extragenital donovanosis are described. The presenting features were ulceration of the anterior abdominal wall, discharging sinuses of the neck, and an abscess of bone, respectively. Two cases were diagnosed recently and were the only instances of extragenital infection in a series of 47 patients with confirmed donovanosis diagnosed at a public health laboratory in Perth, Western Australia, between 1979 and the beginning of 1985. The third case, which occurred in 1977, was found in the records of a major teaching hospital.

Primary endometrial and endocervical granuloma inguinale (donovanosis). Case report

Primary endometrial and endocervical granuloma inguinale (donovanosis) was diagnosed in an 18-year-old Melanesian woman in Papua New Guinea. Granulomatous involvement of the parametrium, salpinges, ovaries, and ureters was associated with ureteric obstruction and bilateral hydronephrosis. Granuloma inguinale of the cervix, labia majora, and anus developed after diagnostic endometrial curettage. Treatment with tetracycline and later chloramphenicol had to be stopped because of poor patient compliance. Hysterectomy was performed, after which the patient made a good recovery. This appears to be the first case of primary endometrial and endocervical granuloma inguinale to be reported.

Extragenital granuloma inguinale in North Queensland

Two cases of extragenital granuloma inguinale are presented. A 41-year-old female presented with fever, a swollen knee joint and osteolytic lesions involving distal bones, and a 49-year-old male had multiple faecal fistulae in the lower abdomen with extensive involvement of pelvic organs. The diagnostic difficulties presented by such cases and the various types of extragenital pathology that have been described in this disease are discussed.

Granuloma inguinale simulating advanced pelvic cancer

This paper describes a case of multiple disease in an Aboriginal woman. Granuloma inguinale, of unusual severity and extent, which closely simulated advanced pelvic malignant disease, was included. Some problems of the diagnosis are discussed.