Donovanosis With Bowen Disease.

A 45-year-old farmer presented with ulcers and plaques over his scrotum for the past 4 to 5 years. The condition started as a small lesion on the shaft of the penis, which improved with treatment; however, after 2 to 3 months, papulonodular lesions developed on the scrotum, which increased in size and subsequently broke down to form ulcers. He denied drug abuse but had a history of multiple unprotected sexual exposures. He was prescribed oral antibiotics, which improved the lesions, but he failed to take the antibiotics for more than a week. He also used powders, lotions, and salves (exact nature not known), which did not help and sometimes even burned the skin. After stopping the medicine, he developed new lesions that followed a similar course. Examination revealed nontender ulcers on the scrotum with raised, rolled-out margins and pale red, granulation tissue that bled on touch (Figure 1). In addition, there were nodules with a pinkish red granular surface and scaly erythematous plaques on the scrotum. Regional lymph nodes were not enlarged.

Malignant transformation of donovanosis (granuloma inguinale) in a HIV-positive patient.

Donovanosis is endemic in various parts of the world. Although donovanosis has been reported to co-exist with the human immunodeficiency virus (HIV) infection, to our knowledge there have been no reports of co-existent squamous cell carcinoma (SCC) in an HIV positive patient. In our case the patient did not respond to treatment for donovanosis and on biopsy we realized that the patient had coexistent SCC, which is hitherto unreported with granuloma inguinale.

Bilateral psoas abscess in a case of granuloma inguinale.

The authors present a case of disseminated granuloma inguinale with bilateral psoas abscesses. Infection with calymmatobacterium granulomatis is usually localized to the genital organs but rarely may be disseminated. A search of the literature revealed that only two cases of psoas abscesses due to calymmatobacterium granulomatis were previously reported

Sexually Transmitted Infections.

Sexually transmitted infections (STIs) remain a significant burden on public health in the United States. Primary prevention counseling with early diagnosis and treatment remain the best methods to decrease the incidence of STIs. Through significant public heath interventions, the incidence of gonorrhea, Chlamydia, and trichomoniasis is decreasing; however, the incidence of primary and secondary syphilis is increasing. Human papilloma virus remains the most common STI, but new vaccinations have the possibility of having a significant impact on this virus's disease potential. This review discusses the most common STIs in the United States, focusing on clinical presentation, diagnosis, and treatment.

Granuloma inguinale (donovanosis): an unusual cause of otitis media and mastoiditis in children.

Granuloma inguinale (donovanosis) is seen predominantly in adults (it rarely occurs in children) and mainly affects genital skin and mucosa. Infection occurs at other skin and mucosal sites, and hematogenous dissemination to bone also has been described. The infection responds dramatically to appropriate antibiotic treatment. We present two cases of granuloma inguinale occurring in children (8 months and 5 months of age) causing mastoiditis and external ear discharges. A temporal lobe abscess also developed in the 8-month-old child. Subsequent computed tomography scans showed marked improvement in the brain lesion after treatment. The second child had a polypoid mass in the middle ear that on biopsy showed the features of granuloma inguinale. The mother of this child had biopsy-proven granuloma inguinale of the uterine cervix. These cases indicate that granuloma inguinale can be transmitted during vaginal delivery, and careful cleansing of neonates born to infected mothers is recommended.

Vulvar carcinoma in premenopausal Jamaican women.

Between the years 1958 and 1973, 119 patients with primary invasive cancer of the vulva were treated at the University Hospital of the West Indies, Kingston, Jamaica. Seventy-seven (64.7%) were premenopausal women. Because the pattern of the disease differed from that in late middle and older aged Jamaican women, the results of the disease are presented. The analysis stresses that vulvar carcinoma before menopause in our community is rare in the absence of various sexually transmitted granulomatous diseases of the vulva.

Granuloma inguinale in association with pregnancy and HIV infection.

OBJECTIVES: A retrospective study to confirm the clinical impression of an increasing prevalence of granuloma inguinale (GI) in women, and to evaluate its association with pregnancy and HIV infection. METHODS: Clinical records of all patients with a definitive diagnosis of GI attending the gynecology and antenatal clinics at King Edward VIII Hospital, Durban, South Africa, over a period of 36 months (January 1991-December 1993). RESULTS: A total of 123 women were diagnosed with GI. The diagnosis was made by tissue smear alone in 21% (n = 26), histology 43% (n = 53) and by a combination of smear and histology in the rest. Forty-two percent (n = 52) were pregnant. The only difference between pregnant and non-pregnant women were the presence of rectal and pelvic lesions in the latter. Sixty-nine percent (n = 36) delivered vaginally while the remaining (n = 16) were delivered by cesarean section. The indications for cesarean section were obstetric except for a patient in labor with extensive untreated vulval granuloma. In the majority (85%) GI had no influence on pregnancy outcome. There was no evidence of congenital GI in the neonates. Twenty-seven percent (30/113) had positive syphilis serology and 16% (18/110) had antibody to HIV. There were no differences in the clinical features and outcome of HIV positive and negative women. CONCLUSION: This study shows that GI is increasing in pregnancy in Durban, South Africa. Despite the concern that pregnancy promotes dissemination of GI, such an effect could not be established as the clinical response to treatment and outcome were similar in both pregnant and non-pregnant women. Infection with HIV also did not alter the clinical presentation and outcome of the disease in the patients studied.

Pseudoelephantiasis of the penis following donovanosis.

Pseudoelephantiasis of the penis, an unusual sequel of longstanding donovanosis with otherwise characteristics clinical expression, is reported in a young man. The diagnosis was confirmed by the demonstration of Donovan bodies in Giemsa stained tissue smears and tissue sections.

Sexually transmitted diseases.

This article summarizes the major sexually transmitted diseases with an emphasis on diagnosis, therapy, and follow-up. Topics included are syphilis, gonorrhea, herpes genitalis, nongonococcal urethritis, lymphogranuloma venereum, granuloma inguinale, chancroid, condyloma acuminatum, molluscum contagiosum, and venereally transmitted gastrointestinal disease.

Disseminated donovanosis (granuloma inguinale) with osteomyelitis of both wrists.

Donovanosis is a sexually transmitted infection which presents with genital ulceration and inguinal lymphadenopathy. Rarely, it presents with extra-genital manifestations. We present a case of disseminated donovanosis with cervical ulceration, massive pelvic lymphadenopathy, osteomyelitis of the wrists and septic arthritis of the knees and right elbow. A 23-year-old gravida two presented with wasting, oedema, ascites, bilateral iliac lymphadenopathy, anaemia and a large ulcer of the cervix uteri. Two months later in the outpatient clinic, she was much improved but still had post-coital bleeding and a hyperaemic cervix, suggestive of persistent infection. The course of antibiotics was therefore repeated. Histopathological examination of a specimen from colposcopic biopsy of the cervix uteri revealed granuloma inguinale. She improved after several courses of antibiotics, blood transfusion, surgical débridement and aspiration of affected joints.

Squamous cell carcinoma complicating donovanosis not a thing of the past!

Donovanosis causes granulomatous ulceration of genitalia and neighbouring sites with little tendency to heal spontaneously. It is uncommonly seen nowadays in sexually transmitted infection clinics of north India. The present case is reported for its scarcity and to make clinicians aware of this disease which may rarely accompany carcinoma.

Genital elephantiasis due to donovanosis: forgotten but not gone yet ...

Genital elephantiasis is a disease that is characterized by massive enlargement of the genitalia. Early aetiological diagnosis is of paramount importance so that development of genital elephantiasis can be prevented; otherwise it is not completely reversible with medical therapy and often requires surgical intervention. Chronic mental distress and disability can result as it interferes with daily/routine activities of the affected individual. Over time, the infectious causes of genital elephantiasis have evolved, from syphilis in the pre-penicillin era to donovanosis, lymphogranuloma venereum and recently filariasis, tuberculosis, leishmaniasis, HIV and chromoblastomycosis. With a declining prevalence globally, donovanosis is at risk of being forgotten as a cause of genital swelling; however, it is known to persist for years without treatment and can lead to complications such as lymphoedema and genital mutilation. We herein present a case of genital elephantiasis that was eventually diagnosed as being due to donovanosis.

Vulvar edema.

Vulvar edema is associated with a variety of conditions. The edema can result from inflammatory conditions, infections, infestations, trauma, pregnancy, tumors and iatrogenic causes. At times, it is difficult to determine the cause of the vulvar edema. Treatment consists of determining the origin of the edema and giving the appropriate therapy for that diagnosis as well as the use of compression and, at times, lymphatic massage.