Donovanosis differential diagnosis: Difference between revisions

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==Overview==
Donovanosis must be differentiated from other diseases that cause genital ulcers without [[lymphadenopathy]] including: primary or secondary [[syphilis]], [[chancroid]], [[herpes simplex]], [[amoebiasis]], and [[squamous cell carcinoma]]. [[Sexually transmitted diseases]] characterized as [[genital ulcer diseases]] may present with similar manifestations and lesion characteristics.
 
==Differentiating Donovanosis from Other Diseases==
Donovanosis must be differentiated from other diseases that cause genital [[ulcers]] without [[lymphadenopathy]]:<ref name="pmid12473810">{{cite journal| author=O'Farrell N| title=Donovanosis. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 6 | pages= 452-7 | pmid=12473810 | doi= | pmc=PMC1758360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12473810 }} </ref>
*Primary or secondary [[syphilis]]
*[[Chancroid]]
*[[Herpes simplex]]
*[[Amoebiasis]]
*[[Squamous cell carcinoma]]
 
Other diseases that causes specifically [[granulomatous]] [[ulcers]] include:
*Cutaneous [[tuberculosis]]
*[[Paracoccidioidomycosis]]
*[[Leishmaniasis]]
*[[Pyoderma gangrenosum]]
 
[[Sexually transmitted diseases]] characterized as [[genital ulcer diseases]] may present with similar manifestations and lesion characteristics. A diagnosis based only on the patient’s medical history and physical examination frequently is inaccurate. Patients who have genital, anal, or perianal ulcers should be evaluated with laboratory tests to make a definitive diagnosis.<ref name="GUDCDC">2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/genital-ulcers.htm Accessed February 18, 2016.</ref>
{| style="font-size: 90%;"
! style="background: #4479BA; padding: 5px 5px;" rowspan="2" | {{fontcolor|#FFFFFF|Clinical Characteristic}}
! style="background: #4479BA; padding: 5px 5px;" colspan="5" | {{fontcolor|#FFFFFF|Sexually Transmitted Disease}}
|-
! style="background: #4479BA; padding: 5px 5px; width: 200px;" | {{fontcolor|#FFFFFF|Chancroid}}
! style="background: #4479BA; padding: 5px 5px; width: 200px;" | {{fontcolor|#FFFFFF|Genital Herpes}}
! style="background: #4479BA; padding: 5px 5px; width: 200px;" | {{fontcolor|#FFFFFF|Donovanosis}}
! style="background: #4479BA; padding: 5px 5px; width: 200px;" | {{fontcolor|#FFFFFF|LGV}}
! style="background: #4479BA; padding: 5px 5px; width: 200px;" | {{fontcolor|#FFFFFF|Syphilis}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Cause'''
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[Haemophilus ducreyi]]''
| style="padding: 5px 5px; background: #F5F5F5;" | [[Herpes Simplex Virus]] (HSV-1 & HSV-2)
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[Klebsiella|Klebsiella granulomatis]]''
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[Chlamydia trachomatis]]'' serovars L1, L2, or L3
| style="padding: 5px 5px; background: #F5F5F5;" | ''[[Treponema pallidum]]''
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Type'''
| style="padding: 5px 5px; background: #F5F5F5;" | [[Papule]] evolving to ulcer
| style="padding: 5px 5px; background: #F5F5F5;" | [[Vesicle]] evolving to [[ulcer]]
| style="padding: 5px 5px; background: #F5F5F5;" | Ulcer progressing to [[granuloma]]
| style="padding: 5px 5px; background: #F5F5F5;" | Self-limited papule or ulcer
| style="padding: 5px 5px; background: #F5F5F5;" | Papule evolving to ulcer
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Border'''
| style="padding: 5px 5px; background: #F5F5F5;" | Crater with irregular, sharp margins
| style="padding: 5px 5px; background: #F5F5F5;" | Circular, sharp margins on erythematous base
| style="padding: 5px 5px; background: #F5F5F5;" | Friable base with sharp, raised, rolled margin
| style="padding: 5px 5px; background: #F5F5F5;" | Shallow, smooth border
| style="padding: 5px 5px; background: #F5F5F5;" | Crater with raised edges, smooth margins
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Distribution'''
| style="padding: 5px 5px; background: #F5F5F5;" | Single or multiple
| style="padding: 5px 5px; background: #F5F5F5;" | Multiple, in group/crop
| style="padding: 5px 5px; background: #F5F5F5;" | Single or multiple
| style="padding: 5px 5px; background: #F5F5F5;" | Single or herpetiform
| style="padding: 5px 5px; background: #F5F5F5;" | Multiple
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Texture'''
| style="padding: 5px 5px; background: #F5F5F5;" | Soft
| style="padding: 5px 5px; background: #F5F5F5;" | [[Umbilicated lesions|Umbilicated]]
| style="padding: 5px 5px; background: #F5F5F5;" | Granulomatous
| style="padding: 5px 5px; background: #F5F5F5;" | Firm bump
| style="padding: 5px 5px; background: #F5F5F5;" | Indurated
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Tenderness'''
| style="padding: 5px 5px; background: #F5F5F5;" | Present
| style="padding: 5px 5px; background: #F5F5F5;" | Present
| style="padding: 5px 5px; background: #F5F5F5;" | Absent
| style="padding: 5px 5px; background: #F5F5F5;" | Absent
| style="padding: 5px 5px; background: #F5F5F5;" | Absent
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lesion Exudate'''
| style="padding: 5px 5px; background: #F5F5F5;" | Grey/yellow purulent exudate
| style="padding: 5px 5px; background: #F5F5F5;" | Non-exudative
| style="padding: 5px 5px; background: #F5F5F5;" | Non-exudative but bleeds easily
| style="padding: 5px 5px; background: #F5F5F5;" | Non-exudative
| style="padding: 5px 5px; background: #F5F5F5;" | Non-exudative; non-fluctuant
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Lymphadenopathy'''
| style="padding: 5px 5px; background: #F5F5F5;" | Present and tender in approx. half of patients (typically unilateral)
| style="padding: 5px 5px; background: #F5F5F5;" | Present and tender
| style="padding: 5px 5px; background: #F5F5F5;" | Absent from primary infection; pseudobuboes may occur
| style="padding: 5px 5px; background: #F5F5F5;" | Present and tender
| style="padding: 5px 5px; background: #F5F5F5;" | Present and non-tender (uni- or bilateral)
|}
 
==References==
==References==
<references/>
{{reflist|2}}


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Latest revision as of 17:36, 18 September 2017

Donovanosis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nate Michalak, B.A.

Overview

Donovanosis must be differentiated from other diseases that cause genital ulcers without lymphadenopathy including: primary or secondary syphilis, chancroid, herpes simplex, amoebiasis, and squamous cell carcinoma. Sexually transmitted diseases characterized as genital ulcer diseases may present with similar manifestations and lesion characteristics.

Differentiating Donovanosis from Other Diseases

Donovanosis must be differentiated from other diseases that cause genital ulcers without lymphadenopathy:[1]

Other diseases that causes specifically granulomatous ulcers include:

Sexually transmitted diseases characterized as genital ulcer diseases may present with similar manifestations and lesion characteristics. A diagnosis based only on the patient’s medical history and physical examination frequently is inaccurate. Patients who have genital, anal, or perianal ulcers should be evaluated with laboratory tests to make a definitive diagnosis.[2]

Clinical Characteristic Sexually Transmitted Disease
Chancroid Genital Herpes Donovanosis LGV Syphilis
Cause Haemophilus ducreyi Herpes Simplex Virus (HSV-1 & HSV-2) Klebsiella granulomatis Chlamydia trachomatis serovars L1, L2, or L3 Treponema pallidum
Lesion Type Papule evolving to ulcer Vesicle evolving to ulcer Ulcer progressing to granuloma Self-limited papule or ulcer Papule evolving to ulcer
Lesion Border Crater with irregular, sharp margins Circular, sharp margins on erythematous base Friable base with sharp, raised, rolled margin Shallow, smooth border Crater with raised edges, smooth margins
Lesion Distribution Single or multiple Multiple, in group/crop Single or multiple Single or herpetiform Multiple
Lesion Texture Soft Umbilicated Granulomatous Firm bump Indurated
Lesion Tenderness Present Present Absent Absent Absent
Lesion Exudate Grey/yellow purulent exudate Non-exudative Non-exudative but bleeds easily Non-exudative Non-exudative; non-fluctuant
Lymphadenopathy Present and tender in approx. half of patients (typically unilateral) Present and tender Absent from primary infection; pseudobuboes may occur Present and tender Present and non-tender (uni- or bilateral)

References

  1. ↑ O'Farrell N (2002). "Donovanosis". Sex Transm Infect. 78 (6): 452–7. PMC 1758360. PMID 12473810.
  2. ↑ 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/genital-ulcers.htm Accessed February 18, 2016.


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