USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

GRANULOMA INGUINALE

(DONOVANOSIS)

This disease is caused by Calymmatobacterium granulomatis, a gram-negative
intracellular bacterium. It is uncommon in the United States. The initial lesion is
a painless ulcer.

A vulvar nodule breaks down, forming a painless, beefy red, highly vascular
ulcer with fresh granulation tissue without regional lymphadenopathy.
Lymphatic obstruction can result in marked vulvar enlargement. Chronic
scarring can lead to lymphatic obstruction.

Diagnosis. Culture of the organism is difficult, but microscopic examination of
an ulcer smear will reveal Donovan bodies.

Management. Oral doxycycline or azithromycin for three weeks (CDC-
recommended treatment)

Table II-7-1. Comparison    of  STDs

With    Ulcers No   Ulcers Painful  Ulcers

Chancroid   (painful) Ragged,   soft    edge    inflamed

Chancroid

Granuloma   inguinale

Genital herpes

LGV

Syphilis

Chlamydia

HPV

Gonorrhea

Hepatitis   B

HIV

Chancroid

Genital herpes