GRANULOMA INGUINALE (Donovanosis)

REPORTING INFORMATION  Class B1: Report by the close of the next business day after the case or suspected case presents and/or a positive laboratory result to the local public health department where the patient resides. If patient residence is unknown, report to the local public health department in which the reporting health care provider is located.  Reporting Form(s) and/or Mechanism: Ohio Confidential Reportable Disease form (HEA 3334, rev. 1/09), Positive Laboratory Findings for Reportable Disease form (HEA 3333, rev. 8/05), the local health department via the Ohio Disease Reporting System (ODRS), or telephone.  Additional reporting information, with specifics regarding the key fields for ODRS Reporting can be located in Section 7.

AGENT Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis), is a bipolar, is a gram-negative bacterium.

CASE DEFINITION Clinical Description A slowly progressive ulcerative disease of the skin and lymphatics of the genital and perianal area caused by infection with Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). A clinically compatible case would have one or more painless or minimally painful granulomatous lesions in the anogenital area.

Laboratory Criteria for Diagnosis  Demonstration of intracytoplasmic Donovan bodies in Wright or Giemsa-stained smears or biopsies of granulation tissue

Case classification Suspect: A clinically compatible case without laboratory confirmation.

Confirmed: A clinically compatible case that is laboratory confirmed.

Not a Case: This status will not generally be used when reporting a case, but may be used to reclassify a report if investigation revealed that it was not a case.

SIGNS AND SYMPTOMS Lesions begin as single or multiple subcutaneous papules. Painless, ulcerating lesions enlarge and often coalesce to form a single large ulcer. Chronic/recurrent ulcers are found mainly on the vulva, urethra, perineum/anal area and inguinal region.

DIAGNOSIS See case definition. Syphilis should be ruled-out through serologic testing.

ODH-IDCM GRANULOMA INGUINALE Page 1/Section 3 Revised 7/2011 EPIDEMIOLOGY Source Humans, sexually transmitted in most cases.

Occurrence While common in tropical areas, granuloma inguinale is extremely rare in the United States.

Mode of Transmission Sexual contact, in most instances. As an ulcerative sexually transmitted disease (STD), granuloma inguinale is grouped with chancroid and lymphogranuloma venereum, or LGV (commonly known as the “minor venereal diseases” because of their relatively low prevalence) as potential determinants of HIV acquisition and transmission. Along with early syphilis and genital herpes, the presence of these STDs has been correlated with high rates of seropositivity for HIV infection in certain areas of central Africa.

Incubation Period Incubation is from 8-12 weeks.

PUBLIC HEALTH MANAGEMENT Case Treatment Consult the most recent Centers for Disease Control and Prevention (CDC) published “STD Treatment Guidelines” for recommended therapy. Copies of the guidelines are available from the HIV/STD Prevention offices and on the internet at the CDC Web site: (http://www.cdc.gov/STD/treatment).

Isolation None.

Contacts Every attempt should be made to examine the patient’s sex partners. Public health disease intervention specialists will assist in the follow-up of patients with granuloma inguinale.

ODH-IDCM GRANULOMA INGUINALE Page 2/Section 3 Revised 7/2011