Granuloma Inguinale

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Overview

This sexually transmitted disease is caused by the gram-negative bacterium Klebsiella granulomatis. Treatment is directed against the causative microorganism.

First Steps

1. Azithromycin 1 gram orally once weekly for 6 weeks, or until the ulcer has healed (but for at least 3 weeks).

Alternative Steps

1. Azithromcyin 500 mg daily for 7 days.

Subsequent Steps

For patients intolerant of or in whom the above therapies fail, try the following for 3 weeks:

1. Ciprofloxacin 750 mg twice daily, or
2. Sulfamethoxazole/trimethoprim 800/160 (double strength) twice daily, or
3. Doxycycline 100 mg twice daily.
4. In refractory cases and for patients with HIV infection, intramuscular or intravenous gentamicin 1 mg/kg three times daily may be given for a few days at the beginning of a treatment regimen.

Pitfalls

1. Because of its rarity in most western countries, this diagnosis is frequently overlooked. Touch preparations and/or biopsies are required to establish the diagnosis and to rule out a squamous cell carcinoma in some cases.
2. Early discontinuation of treatment leads to more frequent relapse.
3. Although gentamicin is highly effective, restrict its use to patients who fail to respond to other safer agents.
4. Evaluate the patient for other sexually transmitted infections.

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