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Sinha S, Sardana K, Agarwal A, Ahuja A. Relapsing donovanosis rhyming with unexplained decline in CD4 count in a person living with HIV/AIDS: Long-term follow up and therapeutic outcome. Int J STD AIDS 2023; 34:423-426. [PMID: 36802827 DOI: 10.1177/09564624231156205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Donovanosis is a chronic genital ulcerative disease caused by the intracellular Gram-negative bacterium Klebsiella granulomatis, reported more frequently in people living with HIV/AIDS (PLHA). Here we present a case of relapsing donovanosis in a PLHA on second line antiretroviral therapy who had episodes of transient unexplained decrease in CD4 counts associated with rapid growth of the lesion and non-responsiveness to treatment followed by clinical resolution coinciding with recovery of the CD4 count.
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Affiliation(s)
- Surabhi Sinha
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Aastha Agarwal
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
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Abstract
Donovanosis is a chronic, progressive, and indolent bacterial disease that affects the skin and mucous membranes of the genital and perigenital regions, often associated with sexual transmission, and with low infectivity. The malignant transformation of donovanosis lesions occurs exceptionally, as is usually seen in long-term ulcerations.
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Affiliation(s)
- Walter Belda Junior
- Department of Dermatology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
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Magalhães BM, Veasey JV, Mayor SAS, Lellis RF. Donovanosis in a child victim of sexual abuse: response to doxycycline treatment. An Bras Dermatol 2018; 93:592-594. [PMID: 30066775 PMCID: PMC6063095 DOI: 10.1590/abd1806-4841.20187948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/06/2018] [Indexed: 11/21/2022] Open
Abstract
Donovanosis is a chronic infectious disease caused by the Gram-negative bacteria Klebsiella granulomatis, which mainly affects the skin and mucous membranes of the genital, perigenital, and inguinal regions. Also known as venereal granuloma or granuloma inguinale, it is endemic in tropical and subtropical regions of the globe and often associated with sexual transmission. We report the case of an 11-year-old female victim of chronic sexual abuse, who was diagnosed with donovanosis and presented a good therapeutic response to doxycycline.
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Narang T, Manhas A, Kumar B. Donovanosis With Bowen Disease. Skinmed 2017; 15:73-75. [PMID: 28270316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 45-year-old farmer presented with ulcers and plaques over his scrotum for the past 4 to 5 years. The condition started as a small lesion on the shaft of the penis, which improved with treatment; however, after 2 to 3 months, papulonodular lesions developed on the scrotum, which increased in size and subsequently broke down to form ulcers. He denied drug abuse but had a history of multiple unprotected sexual exposures. He was prescribed oral antibiotics, which improved the lesions, but he failed to take the antibiotics for more than a week. He also used powders, lotions, and salves (exact nature not known), which did not help and sometimes even burned the skin. After stopping the medicine, he developed new lesions that followed a similar course. Examination revealed nontender ulcers on the scrotum with raised, rolled-out margins and pale red, granulation tissue that bled on touch (Figure 1). In addition, there were nodules with a pinkish red granular surface and scaly erythematous plaques on the scrotum. Regional lymph nodes were not enlarged.
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Affiliation(s)
- Tarun Narang
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;
| | - Ashwini Manhas
- Department of Microbiology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Patiala, India
| | - Bhushan Kumar
- Silver Oaks Multispecialty Hospital, Mohali, Punjab, India
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Ornelas J, Kiuru M, Konia T, Larsen L. Granuloma inguinale in a 51-year-old man. Dermatol Online J 2016; 22:13030/qt52k0c4hj. [PMID: 27617463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 06/06/2023] Open
Abstract
Granuloma inguinale, or Donovanosis, is a rare, sexually transmitted ulcerative disease primarily affecting the genital area. In this report, we present a case of a 50-year-old man that was diagnosed with granuloma inguinale after a 2-month history of a penile ulcer. Histological analysis demonstrated the presence of Donovan bodies within macrophages, confirming the diagnosis. He was subsequently treated with trimethoprim/sulfamethoxazole with improvement in the ulcer. This case serves as a reminder to clinicians that although granuloma inguinale is rarely encountered in the US, it should still be suspected in patients with non-healing penile ulcers.
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Affiliation(s)
- Nadia Ahmed
- Department of Genitourinary Medicine, Mortimer Market Centre, London, UK.
| | - Ashendri Pillay
- Department of Paediatric Infectious Diseases, King Edward VIII Hospital, KwaZulu-Natal, South Africa
| | - Melissa Lawler
- Department of Paediatric Infectious Diseases, King Edward VIII Hospital, KwaZulu-Natal, South Africa
| | - Raziya Bobat
- Department of Paediatrics, University of KwaZulu-Natal, South Africa
| | - Moherndran Archary
- Department of Paediatric Infectious Diseases, King Edward VIII Hospital, KwaZulu-Natal, South Africa
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Sardana K, Garg VK, Arora P, Khurana N. Malignant transformation of donovanosis (granuloma inguinale) in a HIV-positive patient. Dermatol Online J 2008; 14:8. [PMID: 19061590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Donovanosis is endemic in various parts of the world. Although donovanosis has been reported to co-exist with the human immunodeficiency virus (HIV) infection, to our knowledge there have been no reports of co-existent squamous cell carcinoma (SCC) in an HIV positive patient. In our case the patient did not respond to treatment for donovanosis and on biopsy we realized that the patient had coexistent SCC, which is hitherto unreported with granuloma inguinale.
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Affiliation(s)
- Kabir Sardana
- Dermatology, Maulana Azad Medical College, Delhi, India.
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Ferreres JR, Marcoval J, Vicente A, Medina M, Lailla JM, González-Enseñat MA. [Imported donovanosis in an adolescent girl]. Actas Dermosifiliogr 2008; 99:574-575. [PMID: 18682176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Abstract
Ten patients with donovanosis were treated with thiamphenicol for two weeks. In eight of them, included two HIV infected patients, lesions healed. The safety profile of thiamphenicol makes it a useful and cost-effective agent in the management of donovanosis. Randomized controlled trials should be conducted with these treatment options.
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Affiliation(s)
- Walter Belda
- Department of Dermatology, School of Medicine, University of São Paulo, Brazil
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Abstract
We report on a patient from a London clinic, (a Jamaican heterosexual man known to have herpes) who has donovanosis and syphilis in a single genital ulcer. The case highlights the importance of careful clinical examination of genital ulcers.
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Affiliation(s)
- M Samuel
- Department of Genitourinary Medicine, Kings College Hospital, Caldecot Centre, 15-22 Caldecot Road, Camberwell, London SE5 9RS, UK.
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Rashid RM, Janjua SA, Khachemoune A. Granuloma inguinale: a case report. Dermatol Online J 2006; 12:14. [PMID: 17459300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Granuloma inguinale is common in certain regions of the world, however, it is rarely reported in the United States. It is the result of infection by Calymmatobacterium granulomati, although current literature proposes to re-classify this organism as Klebsiella granulomati. Here we report a case of granuloma inguinale, review the literature, and discuss historical context, treatment options, and differential diagnosis.
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Caumes E, Janier M, Dupin N, Alcaraz I, Timsit FJ, Denoeux JP. [Donovanosis (inguinal granuloma)]. Ann Dermatol Venereol 2006; 133:2S35. [PMID: 17072171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Da Costa JB, Domingues D, Castro R, Exposto F. [Genital ulcers caused by sexually transmitted diseases: current therapies, diagnosis and their relevance in HIV pandemy]. ACTA MEDICA PORT 2006; 19:335-42. [PMID: 17328851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The sexual transmitted pathogens associated with genital ulcers are Treponema pallidum, Haemophilus ducreyi, Calymmatobacterium granulomatis, Chlamydia trachomatis and Herpes simplex virus type 1 or 2. Although geographic differences still exist, herpetic infections prevalence is growing worldwide as the most frequent ulcerative sexual transmitted disease. The failure of the many different used guidelines in achieving a sustained reduction in the number of new cases, in particular the WHO syndromic management, leads into an over treatment of bacterial agents and missing of viral agents. This situation is also associated with poor efficacy and wasting of economical resources. Ulcerative and non-ulcerative sexual transmitted diseases are important in the world HIV pandemy because they promote HIV transmission and are also associated with the disease evolution. Portugal had until recently the highest incidence of HIV infection in Europe and that points out to importance of treating and control of both ulcerative and non-ulcerative sexual transmitted diseases in order.
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Abstract
The authors present a case of disseminated granuloma inguinale with bilateral psoas abscesses. Infection with calymmatobacterium granulomatis is usually localized to the genital organs but rarely may be disseminated. A search of the literature revealed that only two cases of psoas abscesses due to calymmatobacterium granulomatis were previously reported
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Affiliation(s)
- W West
- Section of Radiology, Department of Surgery, The University of the West Indies, Mona, Jamaica.
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Abstract
Although sexually transmitted diseases (STDs) are underreported and underrecognized, they are a major source of morbidity, mortality, and represent a major socioeconomic cost in developing and industrialized nations. Individuals who develop STDs are often coinfected with human immunodeficiency virus (HIV). Coinfection with HIV both facilitates the natural history of STDs and worsens the clinical picture. The objective of this article is to provide a review to the practicing clinician on the epidemiology, clinical manifestations, methods of diagnosis, and treatment for four cutaneous STDs--chancroid, genital herpes, granuloma inguinale, and lymphogranuloma venereum--in coinfected HIV patients.
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Affiliation(s)
- Jashin J Wu
- Department of Dermatology, University of California College of Medicine Irvine, Irvine, California, USA
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Abstract
INTRODUCTION Azithromycine is recommended in the treatment of donovanosis with a 7-day treatment cycle. We report the efficacy of a single cure of 1 gram in two patients. OBSERVATIONS Four patients, presenting with donovanosis, were treated with azithromycine according to 2 regimens. The first used 500 mg/d the molecule during 1 week, the second used azithromycine in single cure of 1 gram. The latter led to the complete cure of 2 patients. DISCUSSION Many antibiotics are used in the treatment of donovanosis. Since 1996, Australian authors have used azithromycine in this indication. A single dose of this molecule appears effective in recent and confined donovanosis.
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Affiliation(s)
- E Clyti
- Service de Dermatologie, Centre Hospitalier Andrée Rosemon, BP 6006, 97306 Cayenne, Guyana.
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Abstract
A 23-year-old male presented with oral ulcers. Tissue smear showed Donovan bodies. The patient was treated with oral tetracycline.
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Affiliation(s)
- S Veeranna
- Department of Skin & STD, JSS Hospital, Ramanuja Road, Mysore-4, Karnataka, India
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van der Griend B, Rane A, Green E. An uncommon cause of a destructive vulval lesion. Aust N Z J Obstet Gynaecol 2001; 41:459-60. [PMID: 11787928 DOI: 10.1111/j.1479-828x.2001.tb01332.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a case of a 39-year-old woman with a vulval lesion, which macroscopically looked consistent with a fungating squamous cell carcinoma of the vulva. However, further investigations demonstrated a less common cause for this presentation.
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Affiliation(s)
- R W Roest
- Department of Dermatovenereology, University Hospital Dijkzigt, Rotterdam, The Netherlands.
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Abstract
Donovanosis has been ignored for many years until recently. The condition still has a limited geographical distribution. A significant epidemic of donovanosis has been identified in KwaZulu/Natal, South Africa where it may be a risk factor for acquiring HIV in men. After a gap of more than 30 years, the organism was cultured by researchers in Durban, South Africa and Darwin, Australia. Polymerase chain reaction (PCR) techniques for donovanosis were developed soon after, most recently using a colorimetric detection system. Similarities between the causative organism, Calymmatobacterium granulomatis and Klebsiella spp. were confirmed. A proposal that the organism be reclassified under the genus Klebsiella has been put forward. Azithromycin has been confirmed as the drug of choice but is yet to be accepted universally because of cost issues. Treatment in patients with significant HIV induced immune deficiency may need to be prolonged. A donovanosis eradication programme is underway amongst the aboriginal community in Australia. Elsewhere, management through current syndromic guidelines for genital ulcers are yet to be validated in areas where donovanosis is endemic. PCR testing should enable further recognition of donovanosis and lead to more concerted efforts in disease control and possible eradication.
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Affiliation(s)
- N O'Farrell
- Pasteur Suite, Ealing Hospital, Uxbridge Road, London UB1 3HW, UK
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Affiliation(s)
- F J Bowden
- AIDS-STD Unit, Territory Health Service, Darwin, Australia
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Bowden FJ, Skov SJ. Treating donovanosis. Aust Fam Physician 1999; 28:1103-4. [PMID: 10615749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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National guideline for the management of donovanosis (granuloma inguinale). Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). Sex Transm Infect 1999; 75 Suppl 1:S38-9. [PMID: 10616381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Azithromycin/therapeutic use
- Ciprofloxacin/therapeutic use
- Contraindications
- Doxycycline/therapeutic use
- Female
- Genital Diseases, Female/diagnosis
- Genital Diseases, Female/drug therapy
- Genital Diseases, Female/microbiology
- Genital Diseases, Male/diagnosis
- Genital Diseases, Male/drug therapy
- Genital Diseases, Male/microbiology
- Gentamicins/therapeutic use
- Granuloma Inguinale/diagnosis
- Granuloma Inguinale/drug therapy
- Humans
- Infectious Disease Transmission, Vertical
- Male
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/microbiology
- Ulcer/diagnosis
- Ulcer/drug therapy
- Ulcer/microbiology
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Abstract
An extremely rare case of primary extragenital donovanosis affecting the dorsa of right foot is reported. Clinical and histopathological features of the disease are described and the rarity, absence of genital lesions, and consequent difficulty in diagnosis are discussed.
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Affiliation(s)
- M V Rao
- Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Abstract
BACKGROUND AND OBJECTIVES Granuloma Inguinale (GI) is an endemic sexually transmitted disease (STD) in India. With increasing prevalence of human immunodeficiency virus (HIV) among patients with STD at a clinic in Mumbai, a study was conducted to determine clinico-epidemiologic features of GI and HIV. GOAL To determine possible interaction between GI and HIV. STUDY DESIGN Prospective follow-up of 21 consecutive cases (GI in HIV-seropositive individuals) and 29 controls (GI in HIV-seronegative individuals) to determine time to heal. All cases and controls received a standard treatment regimen of erythromycin, 2 g po daily, under supervision until healing occurred. RESULTS Although GI ulcers at recruitment were not significantly larger among HIV-seropositive individuals as compared with those seen among HIV-seronegative individuals (mean size 4.4 cm2 vs. 3.6 sq2; odds ratio [OR] 1.22, confidence interval [CI] .95, 0.63, 2.40; p = 0.52), the former took longer time to heal completely (mean 25.7 days vs. 16.8 days; OR 1.82, CI .95, 0.99, 3.36; p = 0.03) and tended to produce greater tissue destruction (as included in results). CONCLUSION These findings are important because slow-healing GI ulcers with underlying HIV infection, which may be caused by their interaction, will lead to increased transmission of both the infections.
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Affiliation(s)
- P P Jamkhedkar
- Department of Skin/STD, Sir J. J. Hospital, Mumbai, India
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Abstract
A case of extragenital donovanosis in a patient with AIDS is reported from Zimbabwe. Despite the rarity of donovanosis in Zimbabwe it is important that health workers are familiar with this disease since donovanosis increases the risk of HIV transmission and appropriate treatment is often successful even in patients with severe immunodeficiency.
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Affiliation(s)
- C J Sanders
- City of Bulawayo, Health Services Department, Zimbabwe
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Bowden FJ, Savage J. Azithromycin for the treatment of donovanosis. Sex Transm Infect 1998; 74:78-9. [PMID: 9634320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Cliff S, Wilson A, Wansborough-Jones M, Ash S. Disseminated granuloma inguinale secondary to cervical infection. J Infect 1998; 36:129-30. [PMID: 9515686 DOI: 10.1016/s0163-4453(98)93738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Affiliation(s)
- S M Manders
- Division of Dermatology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School at Camden, USA
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Birthistle K, Greig J, Hay P. Failure of trimethoprim in the treatment of donovanosis. Genitourin Med 1997; 73:224-5. [PMID: 9306910 PMCID: PMC1195832 DOI: 10.1136/sti.73.3.224-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Affiliation(s)
- J Mein
- AIDS/STD Unit, Disease Control Centre, Darwin, NT, Australia
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Ahmed BA, Tang A. Successful treatment of donovanosis with ciprofloxacin. Genitourin Med 1996; 72:73-4. [PMID: 8655179 PMCID: PMC1195602 DOI: 10.1136/sti.72.1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
OBJECTIVES To determine the effectiveness of azithromycin, an azalide antibiotic with long tissue half-life, in a pilot study of patients with genital donovanosis in the Northern Territory, Australia. DESIGN Patients with histologically confirmed donovanosis were randomised to receive one of two open-label azithromycin dosage regimens: Regimen A--1.0 g once weekly for 4 weeks; or Regimen B--500 mg daily for 7 days. Patients were assessed at 6 weeks and classified as either "cured", "improved" or "failed". RESULTS Seven patients received regimen A and 4 received regimen B. Six weeks after commencing treatment the genital ulcers of four patients receiving regimen A and one patient receiving regimen B had healed; the lesions of the other six patients (3 in each regimen) were "improved". No patient failed to respond and no significant adverse reaction was recognised. The eleven patients were reviewed after completing the six-week trial; all lesions had re-epithelialised without further antibiotic treatment, no relapses had occurred, the longest follow-up period being seven months. A further 17 patients with donovanosis who were unable to meet the entry criteria were also treated successfully with azithromycin during the study period. CONCLUSIONS This is the first time that azithromycin has been shown to have clinical activity against donovanosis. Poor compliance with prolonged courses of antibiotics is one of the major barriers to control of the disease. Intermittent or short-course therapy, made possible by the long tissue half-life of the drug, could facilitate control of donovanosis in endemic populations if the high cost of medication can be addressed.
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Affiliation(s)
- F J Bowden
- AIDS/STD Unit, Territory Health Services, Darwin, Australia
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Kramer PB. Knowledge about AIDS and follow-up compliance in patients attending a sexually transmitted disease clinic in the highlands of Papua New Guinea. P N G Med J 1995; 38:178-90. [PMID: 9522857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In a survey of 300 consecutive new attenders at the Porgera Health Centre Sexually Transmitted Disease Clinic information was obtained regarding knowledge about AIDS from male and female attenders. The differences between the sexes regarding a variety of socioeconomic variables, knowledge about AIDS and their compliance to follow-up appointments were studied as well as possible relationships between these social variables and the degrees of AIDS knowledge and compliance. Males tended to originate from further afield, be more educated, be either in salaried employment or not working at all, and be single as compared to females. They also admitted to more extramarital sexual contacts and received more adequate treatment. Knowledge about AIDS was also significantly higher amongst male attenders and in this group was correlated strongly with overall educational attainment and employment status but did not show any relationship with the number of extramarital contacts admitted to. Only 9% of the patients knew about condoms and their role in prevention. Follow-up compliance was generally poor, and not significantly higher in those with higher scores of knowledge about AIDS, but showed a relationship with the type of disease being treated and with the ultimate adequacy of treatment received.
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Affiliation(s)
- P B Kramer
- Porgera Health Centre, Enga Province, Papua New Guinea
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Abstract
OBJECTIVES To determine the effectiveness of intramuscular (IM) ceftriaxone sodium in the treatment of chronic donovanosis, and the acceptability to patients and staff of supervised outpatient treatment in rural clinics. METHODS We collected demographic and sexual health data from participants using a standard questionnaire, and recorded their donovanosis lesions at baseline using genital diagrams. Treatment consisted of a single daily IM injection of 1 g ceftriaxone diluted in 2 ml of 1% lignocaine. Clinic staff followed patients for between three and 12 months, enabling the detection of late recurrences. SETTING Rural Aboriginal communities in central Australia. PARTICIPANTS The study describes eight women and four men with chronic donovanosis in detail, and summarises the outcome in 12 additional cases. All cases presented with advanced lesions which had failed to heal on the standard oral antibiotic regimens used in the region. RESULTS The mean duration of infection was 3.0 years (SD 1.9 years), and between four and ten courses of antibiotics had been prescribed for six of the 12 patients. Patients received between 7-26g of ceftriaxone sodium. Clinical improvement was dramatic in most lesions, and four patients healed completely without recurrence after a total 7-10g of ceftriaxone. Mild recurrences responded to further ceftriaxone or short courses of oral antibiotics. Treatment was well tolerated, and both patient and staff compliance high. CONCLUSION Donovanosis is an important cause of chronic genital ulceration in central Australia, and is potentially an important risk factor for HIV transmission in Aboriginal communities. The pharmacokinetics and safety profile of ceftriaxone make it a useful and cost-effective agent in the ambulatory management of donovanosis, especially in remote communities. Supervised multidrug regimens of two or more long-acting agents may provide the best answer in donovanosis, administered through the existing health care infrastructure.
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Affiliation(s)
- A Merianos
- National Centre for Epidemiology and Population Health, Australian National University, Canberra
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Suneja A, Chaudhry R, Ramam M, Agarwal N, Talwar V. A case report on surgically managed elephantoid vulva due to donovanosis. Asia Oceania J Obstet Gynaecol 1993; 19:57-60. [PMID: 8489468 DOI: 10.1111/j.1447-0756.1993.tb00347.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A Suneja
- Department of Gynaecology and Obstetrics, University College of Medical Sciences, Delhi, India
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Engelkens HJ, Niemel PL, Menke HE, Stolz E. [Granuloma inguinale (donovanosis): vigilance should be exercised]. Ned Tijdschr Geneeskd 1993; 137:396-9. [PMID: 8446195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- H J Engelkens
- Afd. Dermatologie en Venereologie, Academisch Ziekenhuis Rotterdam-Dijkzigt
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Evans DT. Failure of single dose ceftriaxone in donovanosis (granuloma inguinale). Genitourin Med 1992; 68:146. [PMID: 1582667 PMCID: PMC1194839 DOI: 10.1136/sti.68.2.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Affiliation(s)
- N O'Farrell
- Ngwelezana Hospital, Empangeni, Natal, South Africa
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Perret JL, Gomez de Diaz M, Kombila M, Nguemby-Mbina C. [What course to take in donovanosis? Apropos of a new case report (Hospital Center of Libreville- Gabon)]. Med Trop (Mars) 1991; 51:359-61. [PMID: 1943649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J L Perret
- Médecin des Hôpitaux des Armées, Centre Hospitalier de Libreville, Libreville, Gabon
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Affiliation(s)
- N O'Farrell
- City Health Sexually Transmitted Diseases Department, King Edward VIII Hospital, Congella, Durban, South Africa
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48
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Affiliation(s)
- C Ramanan
- Department of Dermatology, J. N. Hospital and Research Centre, Bhilai (M.P.), India
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Faro S. Lymphogranuloma venereum, chancroid, and granuloma inguinale. Obstet Gynecol Clin North Am 1989; 16:517-30. [PMID: 2687744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Lymphogranuloma venereum, chancroid, and granuloma inguinale are three uncommon bacterial infections in the United States; however, with the increase in immigrants from Asian and South American countries, the incidence of these infections is rising. This article reviews the clinical manifestations, diagnosis, and therapy of these infections.
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Affiliation(s)
- S Faro
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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50
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Ronald AR, Plummer FA. Chancroid and granuloma inguinale. Clin Lab Med 1989; 9:535-43. [PMID: 2676322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Haemophilus ducreyi is a fastidious pathogen that can be routinely cultured with the appropriate media and incubation environment. Prostituted women appear to be the usual reservoir. In Africa, chancroid is emerging as the major risk factor for acquisition of HIV-1 following heterosexual intercourse. Despite the emergence of resistance to a number of antimicrobial agents, H. ducreyi remains susceptible to ceftriaxone, erythromycin, and ciprofloxacin. Control and eradication of outbreaks of chancroid have been successful on several occasions in Western societies; strategies to control epidemic genital ulcer disease are required in developing countries. Granuloma inguinale is caused by a small, gram-negative rod, which has never been well-characterized. The presence of Donovan bodies is a specific and sensitive diagnostic characteristic. Very little is known about the epidemiology of the disease. Specific treatment programs using trimethoprim-sulfamethoxazole or erythromycin seem to be quite effective. Control strategies have not been adequately investigated.
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Affiliation(s)
- A R Ronald
- Department of Internal Medicine, University of Manitoba, Canada
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