What is the treatment for granuloma inguinale?

Treatment of Granuloma Inguinale (Donovanosis)

Doxycycline 100 mg orally twice daily for at least 3 weeks or until all lesions have completely healed is the recommended first-line treatment for granuloma inguinale. 1

First-Line Treatment Options

• Doxycycline 100 mg orally twice daily for at least 3 weeks or until all lesions have completely healed 1
• Azithromycin 1 g orally once weekly until complete healing is achieved 2

Alternative Treatment Options

• Erythromycin base 500 mg orally four times a day for at least 3 weeks or until lesions have healed 3
• Ciprofloxacin 500 mg orally twice daily for at least 3 weeks or until lesions have healed 3
• Trimethoprim-sulfamethoxazole one double-strength tablet orally twice daily for at least 3 weeks 3

Treatment Considerations

• Treatment should be continued until all lesions have completely healed, which may take longer than the minimum 3-week course 2
• Relapse can occur 6-18 months after apparently effective therapy, requiring careful follow-up 4
• In pregnant and lactating women, erythromycin is the preferred treatment option as doxycycline and ciprofloxacin are contraindicated 3

Diagnostic Approach

• Diagnosis is based on visualization of Donovan bodies (dark-staining intracytoplasmic inclusions within histiocytes) in tissue crush preparations or biopsies stained with Wright or Giemsa stain 4
• Clinical presentation typically includes painless, progressive ulcerative lesions with a characteristic "beefy red appearance" that bleed easily on contact 4
• The causative organism (Calymmatobacterium granulomatis, proposed reclassification as Klebsiella granulomatis) cannot be cultured on standard microbiologic media 4, 5

Management of Complications

• For extensive or complicated cases with tissue destruction, surgical intervention may be necessary in addition to antibiotic therapy 6
• HIV testing should be performed in all patients diagnosed with granuloma inguinale, as co-infection may lead to more severe disease requiring longer treatment 3
• Patients should be tested for other STIs including syphilis, as co-infections are common 3

Follow-Up Recommendations

• Patients should be monitored until complete healing of all lesions is observed 2
• Sexual partners within 60 days before the onset of symptoms should be examined and treated if necessary 3
• Patients should abstain from sexual contact until all lesions are completely healed 3

Treatment Pitfalls to Avoid

• Inadequate duration of treatment is a common cause of relapse; therapy must continue until complete healing 2
• Secondary bacterial infection of lesions may occur and complicate diagnosis and treatment 4
• Failure to test for and treat co-infections with other STIs may lead to treatment failure 3
• In severe cases, mutilation of genital tissue can occur if treatment is delayed 7