What is a venereal granuloma
Sexually transmitted diseases are striking in their diversity. In addition to the well-known chlamydia, gonorrhea and syphilis, dangerous diseases such as, for example, donovanosis are also found. In Russia, this disease is not common, but lovers of relaxation in tropical countries, after several random connections with sultry aborigines, can feel all the charms of this scourge. How does donovanosis manifest itself and how to treat it?
Donovanosis: what is it?
Donovanosis is a sexually transmitted disease that causes the bacterium Calymmatobacterium granulomatis, or Donovan's body. The causative agent of infection is easily detected under a microscope. The bacterium has the shape of a stick in a capsule, sometimes covered with a dense shell.
This STD was opened in 1905 in Ireland. Other names for the disease: Broca's donovanosis, tropical granuloma, venereal granuloma, inguinal granuloma. Donovanosis is mainly prevalent in hot countries. But cases of infection are rare in Russia. The victims are usually tourists who had unprotected sex with local residents of the subtropics. In rare cases, infection occurs through the contact-household route through small cuts and abrasions.
A nursing mother who has had donovanosis can pass the infection to her baby through breast milk. Young children are very difficult to tolerate this infection.
The causes of the disease
Venereal granuloma is a problem of many people living in the zone of humid tropical and subtropical climate, as well as those who decided to relax there to the fullest. Calymmatobacterium granulomatis survives only in a warm and humid environment and quickly dies outside the carrier. The causes of donovanosis are as follows:
- Promiscuous sexual intercourse. The causative agent of infection is easily transmitted by unprotected sexual contact. The genital area is an ideal medium for the reproduction of the Donovan bacteria. The best defense against this scourge is a condom.
- The harmful effects of a humid hot climate. When clothes do not dry, and the ambient temperature does not drop below 30 degrees, Donovan's little bodies feel very comfortable. In such a climate, even domestic tropical granuloma infection is not uncommon.
- Non-observance of personal hygiene. Dirt, sweat and moisture are a beneficial environment for the multiplication of many bacteria. You can minimize the risk of getting donovanosis if you regularly take a shower and use wet antibacterial wipes.
Causes of Granuloma
The causative agent of donovanosis is calymmatobacterium granulomatis. This is a small microorganism resembling an egg. He prefers a warm, humid environment, so when left without a carrier, he quickly dies. Inguinal granuloma is widespread in tropical regions, but is rare for the CIS countries. Another name for this bacterium is the body of Donovan, so the disease got its name.
Inguinal granuloma (granuloma inguinale) in most cases develops when the pathogen is sexually transmitted from an infected person to his partner. In women, the manifestations of the disease may be less pronounced, therefore European men, who often visit tropical regions at work and often change sexual partners, most often become victims of this disease.
In rare cases, the pathogen can be transmitted through household contacts. This is only possible under certain climatic conditions combining high humidity and air temperature. Non-compliance with personal hygiene rules and living in unfavorable conditions increases the risk of household transmission.
In addition, it was found that people who have weakened immunity are more susceptible to this pathological condition. Among other things, more often there is an infection of those who suffer from various chronic diseases that worsen their general health. Researchers point out that some people have a genetic predisposition to a disease such as donovanosis.
Discovered in 1905 by medical researcher Donovan, the disease is widespread in humid and hot countries. The largest foci of the disease were recorded in India and Vietnam, which gave researchers the opportunity to say that a warm climate with high humidity is needed for the pathogen life cycle.
Infection occurs mainly through sexual contact, but there is a danger of getting sick when contacting at home, because the microorganism uses mucous membranes and places of micro-injuries to penetrate into the human body, especially when ignoring the rules of personal hygiene.
Distribution and transmission paths
This disease is quite exotic for Russia. Compared with other STIs - gonorrhea, syphilis, trichomoniasis - infectious granuloma is rare. It is transmitted only sexually, and only adults are ill with it.
The causative agent of the disease is Calymmatobacterium granulomatis. It is a small egg-shaped bacterium. It is also called the stick of Aragan-Vianna or the body of Donovan. As a result of sexual contact, the bacterium moves from the skin of a sick person to the skin of his partner.
The peculiarity of the microorganism is that it prefers a moist and warm environment. In temperate zones, the bacterium feels uncomfortable. It received the greatest distribution in some regions of African countries, India, South America. Russian tourists who have sexual intercourse with local residents of epidemiologically dangerous countries bring the infection home. The problem is that it is not always possible to protect yourself from infection with a condom.
Map of the global distribution of donovanosis. Shaded countries of the likely permanent presence of infection. Also noted are countries in which imported donovanosis is stably detected
But do not panic. The presence of sexual contact with the carrier does not mean the inevitability of infection. Moreover, donovanosis cannot be infected in everyday life. A bacterium cannot live long outside the human body in our latitudes.
Many consider venereal granuloma a disease that is not worthy of attention. There are undoubtedly more severe STDs. Nevertheless, this disease cannot be completely ignored. Like other sexually transmitted infections, donovanosis is dangerous, first of all, with complications. The disease does not pass spontaneously. If a venereal granuloma is not treated, it is fixed in the body, goes into a chronic form, which is very difficult to get rid of.
Symptoms of inguinal granuloma
How does the pathogen attack on the human body? The insidiousness of the disease lies in the fact that the incubation period lasts a very long time. Up to 80 days may elapse from the moment the bacteria is introduced until the first symptoms appear. Then donovanosis manifests itself in all its glory. The symptoms are mainly: painful nodules with a diameter of about 5 mm appear at the site of contact (mainly genitals). In women, the labia most often affects, in men, the scrotum and glans penis. After a while, the nodules grow and turn into painful, oozing ulcers.
The surface of these ulcers is blood red, and the edges are serrated and raised. Bad smell is almost always absent. But inflammation and swelling of the tissues are visible to the naked eye. Patients usually feel well: there is no temperature or weakness.
If the disease does not occur for the first time and takes on a chronic form, then the symptoms of secondary activation of the infection manifest themselves much worse. Ulcers become larger, become cracked, and exude a putrid odor. The focus of infection also captures more distant parts of the body: the urethra, urethra, vagina, anus. The oral cavity, neck and chest, joints and even the liver can be affected. Bubbles swell under the skin, which are easily confused with inflamed lymph nodes.
Lack of treatment for inguinal granuloma is unacceptable. Ignoring the problem in men can lead to necrosis and even amputation of the penis. Women face a narrowing of the urethra and rectum, as well as discomfort when walking.
Signs of a venereal granuloma
From the moment of infection to the appearance of the first symptoms of donovanosis, three days, or maybe three months, can pass. Easier bacteria penetrate the body through damaged skin. The disease is manifested by the appearance of inflamed papules. Then the formations are covered with red ulcers with a granular surface. The edges of the formation can be jagged or wavy. The papule itself is soft, but surrounded by hyperemic skin.
pictured: ulcerative manifestation of donovanosis on the male genitalia
If the infection is secondary, then ulcerations acquire a dirty gray hue, are covered with dead particles and crusts. Of these, bloody pus stands out, smelling unpleasant.
Favorite localization of sores - genitals. However, the appearance of papules near the anus, groin and other places is not excluded.
At the same time, the patient can feel good - ulcerations do not reveal themselves (they are painless and do not itch).
Forms of the disease
Donovanosis can manifest itself in different ways, depending on the general state of the patient’s health and other factors. The following forms of inguinal granuloma are distinguished:
- Ulcerative. It is characterized by the appearance of nodules, which then turn into ulcers. Ulcers can grow and merge with each other, which subsequently leads to scarring.
- Verrucous. Granulomas turn into warty pink growths that bleed and release fluid. Then crusts form on the surface.
- Blooming. Granulomas form clusters of scarlet color, their surface is soft and velvety. Ulcers in this form of the disease secrete pus, and a person experiences severe itching and pain, both at rest and during movement.
- Sclerosing. Causes abnormalities in the vagina, urethra and anus. The anatomy of these areas is violated, the passages are narrowed, which leads to a significant deterioration in health.
- Necrotic. Constant relapse of the infection causes deepening of ulcers and penetration of the focus of infection into the muscles and bones. Their surface is constantly festering, the color from red or pink changes to serous brown. The well-being of the patient leaves much to be desired: there is a persistent increase in body temperature, headache, aching joints. Infection can enter the internal organs. The main danger is tissue death and sepsis, which often leads to death.
- Mixed. In this case, the patient has symptoms of several types of inguinal granuloma.
Donovanosis (venereal granuloma, inguinal granuloma) is a sexually transmitted disease that is characterized by a chronic, steadily progressing course. Distributed in countries with a hot and humid climate: India, Burma, Vietnam, Central and South Africa. For Europe and Russia, the disease is relevant due to the development of international cooperation, tourism.
Donovanosis is anthroponosis: only people suffer from it. Its causative agent is Calymmatobacterium granulomatis, a bacterium described in 1905 by the scientist Donovan (synonym: Donovan's body). The disease affects males and females, transmitted during sexual intercourse. In addition, it can be transmitted during prolonged household contact in case of non-observance of personal hygiene rules. Using a condom during intercourse with a sick person is guaranteed to protect against infection.
The disease develops slowly, gradually and therefore patients seek medical help a few months after its onset. The incubation of the pathogen lasts about a month. The majority of cases: adults who have sex.
Course of the disease
The incubation, asymptomatic period lasts on average from two weeks to one and a half, two months. At the site of the pest, a papule similar in appearance and size to the trace of the Mantoux vaccination appears, not causing an increase in lymph nodes. The main places of its location are the genitals, both in men and in women.
After a few days, the papule opens and transforms into a slowly increasing, painless ulcer with scanty secretions in the form of a transparent serous fluid and pus with a pungent odor. Following the first, several more appear.
Ulcers do not last long, after a while they close, leaving behind a small scar and the patient for a period of six months to several years forgets about unpleasant symptoms.
If infection occurs through oral contact, the oral cavity is affected., up to the teeth, and in this case, the ulcers are sensitive, and sometimes painful.
With a typical form of the course of genital granuloma, such formations first have a pink hue, a flattened, flat surface and do not bring painful sensations. The formations are soft and do not have serous discharge. Subsequently, the formed papules begin to ulcerate, acquire a reddish tint, their edges become uneven, which contributes to increased bleeding.
Ulcers can later spread to the skin of the perineum. This is a chronic disease, so rashes can disappear and reappear. In the later stages of the development of the pathological process, scarring foci form on the site of the healed ulcers. This causes extremely severe violations.
Diagnosis of Argentinean donovanosis is carried out through a series of laboratory tests, which include microscopic examination of the serous contents of ulcerative neoplasms, smear collection from the surface of ulcers, and the study of the pathogen in smears stained according to Leishman or Romanovsky-Giemsa. Donovan's bodies may not be the only pathogenic microorganisms leading to the formation of granulomas, therefore, additional studies are recommended to identify other types of bacteria - pale treponema, chlamydia, trichomonas.
Types of Donovanosis
Several forms of the disease are considered: verrucous, ulcerative, necrotic, sclerosing, mixed, flowering, mucous.
- Most often, donovanosis manifests itself in ulcerative form. Sores appearing on the genitals are located in groups or singly. They are capable of spreading from the genitals to the inguinal region. One manifestation of this type of venereal granuloma is keloid scars.
- At verrucous ulcers are observed in the form, the bottom of which is strewn with bleeding warty growths. As a result of the appearance of scanty exudate, serous crusts are formed with a bloody admixture. Verrucous form is represented by two varieties: hypertrophic and elephantiasis. In the first case, a pink sore rises above the tissues adjacent to it. It is characterized by painlessness and slow growth.
- Elephantiasis the form is characterized by a strong proliferation of genitals (elephantiasis).
- Blooming form of donovanosis is manifested by ulceration, red with velvety surface. The surrounding tissue is swollen and infiltrated. Pus arising from ulcerative elements smells bad. The affected area is characterized by itching and pain.
- The most severe form of the disease is necrotic. Most often appears as a result of secondary infection. From ulcers, a dense content that has a dark brown color is released. The ulcer deepens to muscle and bone tissue. The genitals are completely destroyed. The disease is complicated by lymphangitis and lymphadenitis. Patients may experience headache, chills, weakness, and fever. It is not excluded the connection of secondary anemia. After a while, the infection passes to the spleen, liver and other organs. Without timely treatment, sepsis develops and death occurs.
- As a result of sclerosing Varieties of infection narrowing of the external opening of the urinary duct, anus and entry into the vagina. The genitals are deformed.
- At mixed form simultaneously observed several types of donovanosis. The outcome depends on the prevailing form.
Symptoms of Donovanosis
- In men, inguinal granuloma affects the foreskin, head of the penis, scrotum, perianal region.
- In women, the inguinal granuloma affects the labia minora and the place of their fusion, it grows anteriorly in the form of the letter V.
- Oral contact leads to granulomas on the cheeks, lips, gums, palate, larynx, nose, and chest or neck.
- At the site of introduction of the pathogen, a nodule with a diameter of up to 5 mm appears, which ulcerates after a few days.
- The ulcer is shallow, painless to the touch, its edges are uneven, and the bottom consists of loose granulations.
- Separated from ulcers: a small amount of a clear, or serous-purulent fluid.
- Regional lymph nodes in size are not enlarged.
- Ulcers gradually heal with the formation of a scar, and a person feels healthy.
In fact, donovanosis is transformed into a chronic form with periodic recurrence - from several months to several years after the initial infection. Complications of donovanosis in the form of secondary infections can lead to serious consequences and even death. Disseminated donovanosis with damage to bones, joints and liver also has an unfavorable prognosis. Pregnancy is a risk factor for such dissemination.
How does infection happen?
The incubation period of the disease is quite variable - from several days to 3-6 months. Bacteria bodies enter the body through the mucous membranes, as well as defects on the skin (scratches, wounds), provoking an inflammatory process not only on the surface of the dermis, but also under the skin. Men and women are at risk with equal probability. Infection occurs in two main ways:
- Sexual. It is considered the most frequent, especially when leading a hectic sexual life, as well as neglecting the rules of personal hygiene. The incidence is not dependent on sexual orientation, although lesbians and homosexuals have a lower percentage of infection.
- Household. It occurs much less frequently, taking place with prolonged exposure to an infected person in close household contact. The possibility of infection of children and adolescents is not excluded.
It is believed that there is a predisposition to donovatosis under certain climatic conditions, as well as due to the individual susceptibility to venereal granuloma.
In the international classification of diseases ICD-10, donovanosis is assigned the code A58 - Inguinal granuloma.
Secondary form of the disease
In the secondary form of venereal granuloma, the symptoms of donovanosis may be more pronounced. In this case, already formed single or multiple formations begin to become covered with scab crusts or necrotic masses. Granulomas gradually increase in size. Pus may begin to separate. An extremely unpleasant odor comes from such rashes. In this case, the general state of health remains unchanged.
In the absence of treatment, a person can comb existing neoplasms and transfer the infection to other parts of the skin.
Donovanosis treatment is carried out using antibacterial agents and antibiotics, which are applied directly to the affected areas of the body. Additionally, the use of biostimulants and vitamin complexes is prescribed to strengthen the patient's weakened immunity. It is necessary to identify and treat all the partners of the patient with whom sexual intercourse has occurred in recent months.
With timely and adequate treatment, the disease is successfully cured. However, in the future, the patient should be monitored by doctors and undergo preventive examinations throughout the year.
Using a condom is a reliable method of contraception, which will avoid a lot of trouble. Do not self-medicate, seek help from a doctor and take only medications prescribed by him.
The most common problems of advanced donovanosis include:
- Scar formation on the mucous membranes during the healing of ulcers, which leads to the growth of connective tissues and, as a consequence, a decrease in the width of the vagina, anus or urethra, which can only be managed by surgery.
- Necrotic tissue necrosis followed by rejection, starting from the skin and tending deep into the body. In the most serious case, destruction of bones and internal organs is possible, even death.
- Inflammation and ulcers can lead to stagnation of blood and lymph in the genitals and limbs and lead to elephantiasis - the growth of subcutaneous tissue to an impressive size.
- Rebirth of skin tissue as a result of constant ulcers, it can give impetus to a decrease in immunity and the development of malignant neoplasms.
Verrucous inguinal granuloma is much less common. This pathological condition is accompanied by the appearance of warty growths. They are formed from existing painless ulcers. Such formations are pale pink. A small amount of exudate can be separated from the warts. After drying, crusts are formed that are tightly attached to the formed granulomas.
Often with this form of the pathology course, the bottom of the ulcer is formed in the tissues, which gradually increases in size, without causing painful sensations. In an unfavorable course, this form of inguinal granuloma can provoke elephantiasis of the external genital organs, in which these parts of the body slowly increase in size. They can reach large sizes and create obstacles to a normal lifestyle.
The timely detection of infection and subsequent treatment will relieve the person affected by donovanosis from the negative consequences. You can not hesitate, because ignoring the disease is fraught with complications, namely:
- narrowing of the urethra, anus and vagina,
- the formation of significant scars that can only be removed surgically,
- the destruction of the anatomical form of the genital organs,
- damage to the liver and spleen,
- violation of vascular conduction and subsequent elephantiasis,
- the development of cancer
- tissue necrosis (including muscle and bone)
- erysipelas and abscess,
The ulcerations resulting from an attack of the pathogen of the inguinal granuloma turn out to be gates for entry and other dangerous infections. Affected skin no longer serves as a protective barrier for bacteria and viruses, which can cause concomitant unpleasant diseases that complicate the treatment of donovanosis. But in the early stages, the inguinal granuloma heals quickly and efficiently. Do not delay to see a doctor in case of alarming symptoms.
Blooming venereal granuloma is often found, which is accompanied by the appearance of papules of juicy red color. The surface of the granulomas is velvety and moist. On palpation, such neoplasms are extremely painful. The area around the granulomas strongly swells.
As the flowering donovanosis develops, the signs of pathology are aggravated. In the future, pus begins to separate. An extremely unpleasant odor appears. In addition, in this case, patients have complaints of severe irritation of the skin of the inguinal region.
The disease can be cured completely with timely diagnosis and adequate antibiotic therapy. The consequences of delayed treatment:
- Necrosis develops, due to which the destruction of the external genital organs, and in some situations internal ones, occurs.
- Cicatricial changes in the genitals, elephantiasis appear.
- There is a risk of squamous cell carcinoma at the site of ulcers.
- Secondary progressive anemia develops.
Donovanosis is an unpleasant and dangerous disease that is fraught with serious complications. Do not wait for a miracle and infect others if you suspect that you are infected with a tropical granuloma.
Timely treatment started gives a very favorable prognosis: after drinking a course of antibiotics, you will soon forget that you were worried about oozing ulcers and other unpleasant sensations. In advanced cases, surgical intervention may be necessary to excise scars. But the operation is not a sentence, after it will become much easier to live.
Since donovanosis often becomes chronic, after recovery it is recommended to visit a venereologist once a year for preventive purposes.
There are contraindications. Specialist consultation required.
- Trimethoprim / sulfamethoxazole (Biseptol) is an antibacterial sulfonamide drug. Dosage regimen: the drug is taken after meals with a sufficient amount of liquid. Assign 800/160 mg orally 2 times a day for 3 weeks to 3 months.
- Doxycycline (a broad-spectrum antibiotic from the tetracycline group). Dosage regimen: 100 mg is prescribed orally 2 times a day for 3 weeks to 3 months.
The most dangerous is necrotizing donovanosis. It is relatively rare. This is a chronic form of the disease most commonly seen in people with immunodeficiency. This condition is accompanied by complications in the form of accession of additional infections. Necrotizing inguinal granuloma is accompanied by the appearance of acute symptoms and a sharp deterioration in the general condition. This form of inguinal granuloma is accompanied by the following signs of pathology progression:
- acute inflammation
- brown discharge
- fast-growing deep ulcers,
- exhaustion of the body
Often people suffering from this pathology attribute their manifestations to ARVI. This increases the risk of complications and the transition of the disease into a systemic form.
With a long chronic course of the disease, an inguinal granuloma can transition to a sclerosing form. This variant of the course of pathology is accompanied by a gradual narrowing of the urethra, vagina and anus. In addition, sclerosing inguinal granuloma quickly leads to deformation of the female genital organs.
Mixed donovanosis is diagnosed when the pathology is accompanied by the symptoms inherent in different forms of this disease. The prognosis of the course of this form of the disease is difficult to predict, since it depends on what signs of the disorder will become predominant.
Prevention of venereal granuloma
Preventive measures can be divided into two groups:
- The first group includes measures that are taken before infection occurs: explaining to people the dangers of accidental sexual intercourse, the need for protective measures during sexual intercourse, and compliance with hygiene requirements. It is important to lead a healthy lifestyle to maintain immunity.
- Activities of the second group are carried out after infection with Calymmatobacterium granulomatis occurred, but the first symptoms did not appear. People who have visited tropical regions and had unprotected sex there are advised to get tested for STIs. If an infectious granuloma causative agent is detected, therapeutic measures are carried out.