Granuloma inguinale (GI) is a sexually transmitted disease occurring in certain areas of the world, ranging from extensive ulcers to mutilation. It is caused by human-only bacteria and is curable with antibiotics.
Of microbes and humans
For a long time the pathogen carried the unspeakable name Calymmatobacterium granulomatis. After the detection methods have become more sophisticated, its relationship with the Klebsiella has been discovered, a type of bacteria whose species Klebsiella pneumoniae usually lives peacefully in the human gastrointestinal tract and can only cause infections of the urinary and respiratory tract in immunocompromised. He was then allowed to join the clan as an aggressive member "Klebsiella granulomatis". The pathogens are carried on through contact with the ulcers, especially in unprotected vaginal and anal intercourse, but more rarely also by finger or from the mother to the child during birth.
Above all, people from socially disadvantaged milieus and poor hygienic conditions are affected. For example, in Australia and Papua New Guinea, the indigenous people are more likely to be infected, in the US more black people and in India more Hindus than Muslims. Which gender predominates varies according to the study, most experts assume that the distribution is equal. The highest rates of morbidity are between 20 and 40 years old.
As the disease usually continues to progress untreated and sufferers, for example due to shame or cost reasons, often require late medical treatment, many illnesses can be observed. Donovanosis and HIV infections are more common and increase the risk of infection.
Hard facts and dark numbers
The GI comes regularly in the
- Caribbean, South India,
- Southern Africa,
- Papua New Guinea, Southeast Asia,
- Australia and Brazil ahead.
In Australia, a few years ago, an attempt was made to eradicate the disease, which had previously occurred in up to 10% of indigenous people. Although this has not been completely achieved, the number of cases has declined sharply through education, prevention and early treatment. In other countries, the GI is sporadic - with fewer than 100 cases registered each year in the US, presumably for the most part travel souvenirs. For Germany there are no numbers.
Symptoms and course
Also in the case of granuloma inguinale, as with many other venereal diseases, "nomen est omen" applies: inflammation-related nodular tissue neoplasms (granulomas) occur in the groin (inguinal). However, since this sign is not specific, not only in the groin and even in an estimated 10-15% of those affected is present, the name Donovanosis is preferred today. This is derived from the Donovan bodies (named after a tropical doctor), an accumulation of the pathogens in certain immune cells.
By the way: Since donovanosis is also called granuloma venerum, there is a risk of confusion with the lymphogranuloma venereum , another sexually transmitted disease! About 10-40 days after the infection small, blue-red, painless ulcers occur at the contact site - usually penile shaft, labia or anal region. Later, these break up and liquid.
If left untreated, the infection spreads and destroys the tissue. Bacterial infections of chronic skin changes ("superinfection") can lead to an unbearable odor. The ulcers can become huge, lead to lymphatic congestion and connective tissue hardening and literally "erode" the genitals. Approximately 0.25% of patients will eventually develop a cancer. In addition, the infection can rarely spread into the body and lead eg to a bone infection or life-threatening blood poisoning.
Proof and therapy
The symptoms are quite visible to experienced doctors in affected areas. The laboratory diagnosis is carried out by microscopic detection of the pathogen in a smear or a tissue sample. Treatment is with antibiotics at least until complete healing - depending on the type of antibiotic for 3-12 weeks. Sexual partners with contact within the last 40 days before onset of symptoms should be investigated and, if necessary, co-treated.
Until complete healing, sexual intercourse should be avoided. Despite adequate therapy, relapses can occur up to 18 months later. Smaller lesions completely heal, larger leave scars.
In a nutshell
- Donovanosis is a specific region of the sexually transmitted disease.
- Infection occurs through contact with the ulcers.
- The first sign is small, painless ulcers.
- A complete cure by means of antibiotics is possible, without therapy it can come to distinct mutilations.
- The sexual partners should be treated if necessary.