Donovanosis is a bacterial disease that has reached endemic proportions in many underdeveloped regions. Because of the scarcity of medical treatment, the disease is often neglected and allowed to reach morbid stages of development. Symptoms of Donovanosis include lesions, ulcers, mutilation and destruction of internal and external tissue, and leakage of mucous and blood. In addition, the destructive nature of Donovanosis seriously increases the risk of contracting other diseases, called superinfection.
Classification
The malady was once called Granuloma Inguinale. Granuloma refers to pathogenic and destructive lesions, and inguinale refers to the inguinal region. Because it commonly infected the inguinal region, it was named inguinale. However, reports of the disease in other places, such as in the oral cavity or above the abdomen led to the renaming of the malady as Donovanosis, after the symptomatic Donovan Bodies. The term Donovan Bodies refers to detectable bacteria that have been encapsulated by histiocytes, a cell of the immune system. Its original genus, Donovania, is actually derived from the term Donovan Bodies. Its speciation as Granulomatis, from granuloma, refers to its characteristic of inducing lesions; the current genus name also refers to granulation. Calymmatobacterium comes from kalymma which means a hood or veil, and refers to the lesions that contain the bacteria. A proposal that the organism be reclassified under the genus Klebsiella has been put forward. This would be a drastic taxonomic change, as the two genuses don’t even share the same phylum. However, Polymerase chain reaction (PCR) techniques using a colorimetric detection system showed a 99% similarity with other species in the Klebsiella genus. The classification is currently being debated.
Symptoms
Small, painless nodules appear after about 10 – 40 days of the contact with the bacteria. Later the nodules burst, creating open, fleshy, oozing lesions. The infection spreads, mutilating the infected tissue. The infection will continue to destroy the tissue until treated. The lesions occur at the region of contact typically found on the shaft of the penis, the labia, or the perianal region. Rarely, the vaginal wall or cervix is the site of the lesion.
Transmission
The Granulomatis (the species name, regardless of the current classification debate) spreads from one region to another, whether it be on the same host or on a different host, through contact with sores. Vaginal and anal intercourse are high risk behaviors to engage in with someone who is infected.
Diagnosis
The patient’s sexual history is requested. Experienced doctors are able to diagnose Donovanosis by only looking at the ulcers. However, it may be necessary for the health care provider to take a sample of tissue in order to correctly diagnose the disease. He or she may decide to add a Wright-Giesmsa stain in order to better view the cells. Additionally, the presence of Donovan bodies in the tissue sample confirms Donovanosis.
Treatment
Three weeks of treatment with erythromycin, streptomycin, or tetracycline, or 12 weeks of treatment with ampicillin are standard forms of therapy. Normally, the infection will begin to subside within a week of treatment, however, the full treatment period must be followed in order to minimize relapse.
Prevention
The disease is effectively treated with anti-biotics, therefore, developed countries, like the United States, have a very low incidence of Donovanosis, (approximately 100 cases reported each year in the United States.) However, sexual contacts with individuals in endemic regions dramatically increases the risk of contracting the disease. Avoidance of these sexual contacts, and STD testing before beginning a sexual relationship are effective preventative measures for Donovanosis.
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