Granuloma inguinale (donovanosis) .. also dermnet
Overseas information: www.cdc.gov/ncidod/diseases/Index.htm

Granuloma inguinale is a bacterial disease caused by the organism Calymmatobacterium granulomatis. The disease is commonly found (endemic) in the tropical and subtropical areas of the world such as Africa Southeast India, Guyana, and New Guinea.

Men are more often affected than women, with a ratio of 2.5 to 1. Peak incidence occurs between 20 and 40 years old. The disease is seldom seen in children or the elderly. It is thought that anal intercourse, rather than vaginal intercourse, is the most frequent source of infection. Fifty percent of the infected men and women have lesions in the anal area also.

The disease begins as a small papule on the genitalia that gradually eats away (erodes) the skin and forms an elevated beefy red velvety nodule (granulation tissue). The granulations are usually painless and bleed easily if traumatised. They grow by slow extension to areas of adjacent skin, gradually destroying the tissue as they enlarge. The growths frequently extend into the inguinal folds (where the legs meet the torso). Untreated disease results in mutilation and destruction of the genital tissue.

In its early stages, it may be difficult to differentiate granuloma inguinale from chancroid. In the later stages, granuloma inguinale may resemble advanced genital cancers, lymphogranuloma venereum, and anogenital cutaneous amoebiasis.

PREVENTION
Granuloma inguinale is a sexually-transmitted disease. Safe sex practices will prevent the spread of granuloma inguinale as well as other sexually-transmitted diseases. Sexual contact with people living in tropical and subtropical climates increases the likelihood of exposure.

SIGNS AND TESTS
Classically, the diagnosis of granuloma inguinale should be considered if genital lesions have been present for a long time and have been progressively enlarging. No serological tests such as that used to detect syphilis are available for diagnosing granuloma inguinale.

Tests that maybe performed include:
- punch biopsy of lesion to provide tissue for microscopic examination and culturing
- culture of tissue sample
- microscopic examination of tissue sample

TREATMENT
A complete cure of granuloma inguinale requires fairly long treatment. A follow-up examination is essential because the disease can reappear after an apparently successful cure.