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Donovanosis diagnosis and treatment

Last updated: March 2014

Background

Donavanosis is caused by Klebsiella granulomatis (formally Calymmatobacterium granulomatis)

It is rarely diagnosed in Australia and is a sporadic disease in Papua New Guinea, South Africa, India and Brazil

Clinical features include four types of lesions.The genitals are affected in 90% of cases and the inguinal region in 10%

  • Ulcerogranulomatous – most common with beefy red ulcers that bleed to thetouch
  • Hypertrophic – usually with a raised irregular edge
  • Necrotic – offensive smelling ulcer causing tissue destruction
  • Sclerotic or cicatricial with fibrous or scar tissue

 

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Diagnosis

Presumptive

Clinical suspicion especially in patients with a sexual history suggestive of exposure and presenting with genital ulceration

Confirmed

Microscopy

Histologic examination of ulcer swab specimen for Donovan bodies using Giemsa or Silver stains

Nucleic Acid Amplification Test

Positive NAAT (nucleic acid amplification test, such as PCR) of lesion swab

  • Specialised laboratory outside of South Australia sent via SA Pathology

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Management

Antibiotic treatment

Azithromycin 1 gram once a week

or

Co-trimoxazole 160/800 mg every 12 hours
Until resolution of lesions

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Patient education

The following points should be discussed:

  • the importance of immediate testing and treating of all sex partners
  • abstinence from sex until treatment completed
  • need for follow up clinical review
  • patient education/provision of literature on Donavanosis
  • that Donavanosis is a notifiable disease.

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Contact tracing

Patients need to be contact traced/referred for contact tracing.

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Follow up

  • Evaluation of symptoms and signs until resolved
  • check reaction to medication
  • enquiry about sexual activity since treatment
  • ensure contact tracing has occurred
  • screen for other STIs (if not done already) and arrange follow up at 3 months for blood borne virus serology and syphilis testing
  • advise condom use until serology at 3 months in case of concomitant undiagnosed HIV, syphilis or hepatitis

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Further information

For further information on diagnosis and management of donovanosis contact Clinic 275.

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Disclaimer

These guidelines are based on review of current literature, current recommendations of the United States Centers for Disease Control and Prevention, World Health Organization, the British Association for Sexual Health and HIV and local expert opinion.

They are written primarily for use by Clinic 275 staff and some flexibility is required in applying them to certain private practice situations.

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