Venereal granuloma (donovanosis) is a chronic, slowly progressive sexually transmitted disease caused by Aragana-Vianna’s bacterium (Callymmatobacterium granulomatis).
The disease is characterized by the development of granulomatous ulcerations of the skin and subcutaneous tissue (not often extensive), mainly in the genital area and perineum. This disease has other names, so medical students, doctors often confuse it with inguinal lymphogranulomatosis, or inguinal lymphogranuloma.
For the first time, a venereal granuloma was identified in 1882 in India by K. Mcleod, who described it as “serpiginosus ulcer”.
The causative agent of venereal granuloma (Callymmatobacterium granulomatis) was discovered in 1905 by the Irish physician C. Donovan, who described intracellular inclusions in exudate from lesions located in the oral cavity of a patient who had lesions in the genital area. Therefore, Callymmatobacterium granulomatis is sometimes called Donovan’s bodies.
Callymmatobacterium granulomatis are pleomorphic rods 1–2 µm long, 0.5–0.7 µm wide, with rounded ends, found singly or may be grouped as cysts. The sticks are traditionally surrounded by a capsule.
Venereal granuloma only affects humans. Infection occurs mainly through sexual contact, much less often – by household. Favorable factors for the spread of infection are a humid climate and high ambient temperature. Non-compliance with the rules of personal hygiene and promiscuity play a role in the emergence and spread of the disease.
Epidemiology and General Pathology
The disease is quite widespread in the southern provinces of China, in some areas of Southeast Asia, Central and South Africa, India, Indonesia, Burma, Vietnam. In the United States, venereal granuloma is often recorded on the coast of the Gulf of Mexico, at the mouth of the Mississippi, on the coast and islands of the Atlantic Ocean, within 25% of the case of the disease is detected in the rest of the country. Not common in Europe.
Some researchers believe that the disease is more common in men than in women.
The incubation period lasts from several days to 3 months or more.
Donovan bodies penetrate through lesions on the plane of the skin and mucous membranes, causing an inflammatory response in the dermis or (more rarely) in the subcutaneous tissue. An early manifestation of the disease is a small raised papule the size of a pea. Sometimes the disease begins with the appearance of a swelling of various sizes under the skin, which softens with the formation of a small abscess, later, as a result of softening, it breaks up and turns into an ulcer, painless, with a raised soft bright crimson bottom, abundant granulations, with jagged or wavy edges.
It is believed that individual susceptibility to venereal granuloma plays a significant role.
Complications of the disease are more common in women. The consequence of donovanosis may be pseudo-elephantiasis of the genital organs, narrowing of the urethra, vagina and anus. All kinds of deformations of the genital organs are noted, in particular in men – phimosis, elephantiasis and necrosis of the penis, narrowing of the urethra, anus and other complications. Very rarely seen epidermoid carcinoma.
The disease can cause mechanical difficulties during urination, defecation, sexual intercourse, childbirth, and even when walking in cases of extensive lesions of the genitals, inguinal or anal area. In 15–20% of patients with donovanosis, pseudo-elephantiasis of the genital organs is observed, which is more common in women.
Treatment is prescribed after the diagnosis is established.