Among venereal diseases there are those that are rare in our country, but this does not exclude the possibility of infection with them. Therefore, a person who is going on a long journey to rest or work should be aware of such a disease as donovanosis (venereal granuloma, inguinal granuloma). What is donovanosis and how does it manifest itself? How to avoid inguinal granuloma?
Inguinal granuloma, or donovanosis. Ways of infection
Granuloma inguinalis is a disease that affects the skin and lymph nodes in the perianal and genital areas. Often the disease is confused with lymphogranulomatosis. Infection with an inguinal granuloma is possible only from person to person, through sexual contact, very rarely - through household contact. With unprotected sexual contact, the causative agent of granuloma, the gram-negative bacterium Klebsiella granulomatis, penetrates through the affected areas on the skin or mucous membrane. For the spread of the infectious process, a humid and hot climate is needed. That is why inguinal granuloma is common in some countries with a tropical and subtropical climate. These are the countries of Southeast Asia, South and Central America, Africa, Northern Australia, Brazil, Mexico. Extremely rare in Europe.
After penetration, the grenuloma groin bacterium begins to multiply without causing any general symptoms. The incubation period can be up to 3 months.
Ulcers in the genital area may indicate donovanosis
A papule appears on the skin at the site of the entrance gate of infection (labia minora, glans penis, perineum, anus), which can reach 3-4 cm in diameter. In the papule, as a result of an inflammatory reaction, the primary element softens with the formation ulcers.
These sores are bright pink in color. They are painless to the touch, the edges of the ulcer are slightly elevated and uneven. From ulcers, serous discharge often appears with a fetid odor of exudate. Ulcers form in the peripheral areas of the tissues, but on contact, other surfaces of the skin folds are affected. It is also possible to transfer infection from ulcers to other areas of the skin by hand.
Clinical picture of inguinal granuloma. Characteristics of ulcers
In the clinical picture, there are 4 forms of inguinal granuloma:
- Ulcerative form. It is characterized by the development of vegetative growths and serpiginous (creeping) growth of ulcers.
- Verrucose form. At the bottom of the ulcers in the verrucous form, bleeding, warty growths of a pale pink color appear. The exudate dries quickly and forms a crust on the surface. Such an ulcer is painless.
- Flowering form. It is characterized by bright red granulations. They are located both along the bottom and along the edges of the ulcers. Exudation, soreness and itching are sharply expressed
- Necrotic form. The most severe course of inguinal granuloma. As a result of the attachment of a secondary bacterial infection to the process, phenomena of necrosis and tissue breakdown appear. In this case, the ulcer grows rapidly along the periphery with a deepening to the fascia, muscles, and sometimes even bones. With this form, complete destruction of the structure of the genital organs is possible. With this form of inguinal granuloma, the general well-being of patients is greatly disturbed - there is fever, weakness, headache and other signs of intoxication. It is possible to spread the infection to absolutely all organs.
Diagnosis and treatment of granuloma inguinal
The diagnosis of inguinal granuloma, or donovanosis, is confirmed by laboratory testing by the presence of Donovan bodies in ulcer margins on Romanowsky-Giemsa stain. Examination of the contents of ulcers should include the identification of treponema and streptobacilli to differentiate the diagnosis.
Antibiotics of the tetracycline series, erythromycin, streptomycin, gentamicin, chloramphenicol are used to treat donovanosis. Azithromycin is considered the most effective. Treatment should be continued until the ulcers are completely epithelialized.
Treatment is very important as there is evidence that untreated ulcers can metaplastic to squamous cell carcinoma. Also, an inguinal granuloma can provoke narrowing of the vagina, anus, urethra and ureter.
For the purpose of prevention, it is important for people who are going to go on vacation to tropical countries and seek adventure to remember about personal hygiene and protection during sexual intercourse. Doctors, having identified strange ulcers on the genital areas, should clarify whether the patient has been in hot countries in the past few years. Although there is an opinion that when infected in countries with a hot climate and upon arrival in Europe, the disease can go away by itself, but this happens only in 10% of cases. The remaining patients are sources of transmission of inguinal granulomatosis.
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