Donovanosis diagnosis and treatment
Last updated: March 2014
- Background
- Diagnosis
- Management
- Patient education
- Contact tracing
- Follow up
- Further information
- Disclaimer
Background
Donovanosis 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 the touch
- Hypertrophic – usually with a raised irregular edge
- Necrotic – offensive smelling ulcer causing tissue destruction
- Sclerotic or cicatricial with fibrous or scar tissue
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
Management
Antibiotic treatment
Azithromycin 1 gram once a week
or
Co-trimoxazole 160/800 mg every 12 hours
Until resolution of lesions
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 Donovanosis
- that Donovanosis is a notifiable disease.
Contact tracing
Patients need to be contact traced/referred for contact tracing.
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
Further information
For further information on diagnosis and management of Donovanosis contact Adelaide Sexual Health Centre.
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 Adelaide Sexual Health Centre staff and some flexibility is required in applying them to certain private practice situations.
