Donovanosis

Infectious agent:

Calymmatobacterium granulomatis, a gram-negative bacillus, the causative agents is now named Klebsiella granulomatis.

Identification:

Clinical features :

Donovanosis is a chronic, progressively destructive infection which affects the skin and mucous membranes of the external genitalia, inguinal and anal regions. Disseminated disease is uncommon but may be life threatening and so should be considered in patients from endemic areas. It presents initially as raised, ‘beefy’ nodules or sores. Lesions may extend peripherally with characteristic rolled edges. Local spread to pelvic and abdominal structures occurs and dissemination to distant sites can also occur.

Method of diagnosis:

The diagnosis is confirmed by demonstrating ‘Donovan bodies’ in Wright or Giemsa-stained smears of granulation tissue or by histological examination of biopsy specimens.

Incubation period:

The incubation period is weeks to months

.

Public health significance and occurrence:

Donovanosis is rare in industrialized countries but endemic in some tropical and subtropical countries and areas including northern Australia. There have been no cases of donovanosis notified in Victoria since at

least 1992.

Reservoir:

Humans.

Mode of transmission:

Transmission is primarily sexual. It is possible that some cases are transmitted non-sexually.

Period of communicability:

The period of communicability is unknown but may be months to years.

Susceptibility and resistance:

Everyone is susceptible to infection.

Control measures:

Preventive measures:

Preventative measures include education about safe sex practices including use of condoms and early detection of infection by testing of people at risk.

Control of case:

First-line treatment for donovanosis is azithromycin. Treatment should be directly observed. Follow-up is important as resolution may be slow and recurrence may occur.

Control of contacts:

Sexual contacts should be examined for possible infection. The likelihood of transmission per act of unprotected intercourse is considered to be low and the likelihood of a long term partner being infected is low to moderate. Contacts dating back weeks or months should be traced according to the sexual

history.

Control of environment:

Not applicable.

Outbreak measures:

Not applicable

.sources of information

• Australian Government Department of Health and Family Services 1998, Contact tracing manual – a practical handbook for health care providers managing people with HIV, viral hepatitis, other STDs and HIV-related tuberculosis.

• Carter, JS, Bowden, FJ, Bastian, I, Myers, GM, Sriprakash, KS, Kemp, DJ 1999, ‘Phylogenetic evidence for reclassification of Calymmatobacterium granulomatis as Klebsiella granulomatis’, International Journal of Systemic Bacteriology, vol. 49, pp. 1695–700.

• Venereology Society of Victoria 2002, National management guidelines for sexually transmissible infections, Venereology Society of Victoria,

http://www.msch.org.au

·         The blue book: Guidelines for the control of infectious diseases