Donovanosis medical therapy
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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]
Overview
Antimicrobial therapy is indicated among patients with donovanosis. Medical therapy for donovanosis includes either oral doxycyline, azithromycin, ciprofloxacin, erythromycin, or trimethoprim-sulfamethoxazole for at least 3 weeks and until all lesions have completely healed. Sexual partners should also be evaluated and treated.
Medical Therapy
- All patients with donovanosis and their sexual partners (within 60 days) should be evaluated and treated with antimicrobial therapy.[1]
- A limited number of studies on Donovanosis treatment have been published.[2]
- Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers.[2]
- Healing typically proceeds inward from the ulcer margins. Relapse can occur 6–18 months after apparently effective therapy.[2]
- Several antimicrobial regimens have been effective, but a limited number of controlled trials have been published.[2]
Antimicrobial Therapy
- Donovanosis[3]
- Preferred regimen: Azithromycin 1 g PO once per week for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (1): Doxycycline 100 mg PO bid for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (2): Ciprofloxacin 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (3): Erythromycin base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (4): Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed
- Note (1): The addition of an Aminoglycoside (e.g., Gentamicin 1 mg/kg IV q8h) to these regimens can be considered if improvement is not evident within the first few days of therapy.
- Note (2): Individuals who have had sexual contact with a patient diagnosed with donovanosis within the past 60 days prior to the onset of the patient's symptoms should also be examined and offered therapy. However, the value of empiric therapy in the absence of clinical signs and symptoms has not been established.
- Note (3): Doxycycline and ciprofloxacin are contraindicated among pregnant women. Pregnancy is a relative contraindication to the use of sulfonamides. Pregnant and lactating women should be treated with the erythromycin regimen, and consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin). Azithromycin might prove useful for treating donovanosis during pregnancy, but published data is lacking.
- Note (4): Individuals with both donovanosis and HIV infection should receive the same regimens as those who are HIV-negative; however, the addition of a parenteral aminoglycoside (e.g., gentamicin) can also be considered.
Follow-Up
Patients should be followed clinically until signs and symptoms resolve.[3]
Treatment of Sex Partners
Persons who have had sexual contact with a patient who has granuloma inguinale within the 60 days before onset of the patient’s symptoms should be examined and offered therapy.
- Note: the value of empiric therapy in the absence of clinical signs and symptoms has not been established.[3]
References
- ↑ Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.
- ↑ 2.0 2.1 2.2 2.3 O'Farrell N (2002). "Donovanosis". Sex Transm Infect. 78 (6): 452–7. PMC 1758360. PMID 12473810.
- ↑ 3.0 3.1 3.2 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/donovanosis.htm Accessed March 03 2016