Donovanosis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]; Nate Michalak, B.A.
Overview
Donovanosis is a sexually transmitted disease that has reached endemic proportions in many underdeveloped regions. Because of the scarcity of medical treatment, the disease often goes untreated. The disease is characterized by painless genital ulcers which can be mistaken for syphilis.[1] However, they ultimately progress to destruction of internal and external tissue, with leakage of mucus and blood. The destructive nature of donovanosis also increases the risk ofsuperinfection by other pathogenic microbes.
Historical Perspective
Donovanosis was first called "serpiginous ulcer" in 1882. Charles Donovan first identified the cause of these genital lesions in 1905, which he called "Donovan bodies," since the etiologic agent was unknown. Aragão & Vianna classified the agent as Calymmatobacterium granulomatis in 1913. However, sequencing analysis by Carter et al. revealed that the agent should be reclassified to Klebsiella granulomatis.
Pathophysiology
Causes
The causative organism, Klebsiella granulomatis, used to be called Calymmatobacterium granulomatis, from the Greek kalymma (a hood or veil), referring to the lesions that contain the bacteria. Prior to this it was called Donovania granulomatis, named after the Donovan Bodies.[2] The species name granulomatis refers to the granulomatous lesions. The organism was recently reclassified under the genus Klebsiella, a drastic taxonomic change, since it involved changing the organism's phylum.
Classification
Donovanosis may be classified by four different clinical appearances of the lesion: ulcerogrnulomatous, hypertrophic or verrucous, nectrotic, or sclerotic. Ulcerogrnulomatous is the most common.
Differential Diagnosis
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.
Epidemiology and Demographics
A true incidence of donovanosis is difficult to determine due to limited knowledge of the disease, limited diagnostic tests, infrequency of disease compared to other sexually transmitted diseases, and occurrence of the disease in areas with limited resources. Most infections occur in people who's ages range from 20 to 40 years. Sex and race are not a predilection for acquiring the disease. Donovanosis is rare in the United States and other developed countries. Donovanosis is endemic in tropical and developing areas, including India, Papua New Guinea, the Caribbean, central Australia, and southern Africa.
Risk Factors
Risk factors for donovanosis include: multiple sex partners, unprotected sexual intercourse, travel to endemic areas, lack of circumcision in males, and poor genital hygiene.
Natural History, Complications, and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Clinically, the disease is commonly characterized as painless, progressive ulcerative lesions without regional lymphadenopathy.
Laboratory Findings
Treatment
Medical Therapy
Prevention
Avoiding all sexual activity is the only absolute way to prevent a sexually transmitted disease such as donovanosis. However, safer sex behaviors may reduce your risk.
The proper use of condoms, either the male or female type, greatly decreases the risk of catching a sexually transmitted disease. You need to wear the condom from the beginning to the end of each sexual activity.