Donovanosis medical therapy: Difference between revisions

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__NOTOC__
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{{Donovanosis}}
{{Donovanosis}}
{{CMG}} {{AE}} {{KD}}
{{CMG}} {{AE}} {{KD}}; {{NRM}}


==Overview==
==Overview==
Antimicrobial therapy is indicated among patients with donovanosis. Medical therapy for donovanosis includes either oral [[doxycyline]], [[azithromycin]], [[ciprofloxacin]], [[erythromycin]], or [[trimethoprim-sulfamethoxazole]] for at least 3 weeks and until all lesions have completely healed. Sexual partners should also be evaluated and treated.
Antimicrobial therapy is the mainstay of treatment for donovanosis. [[Azithromycin]] 1 g PO once per week for at least 3 weeks and until all lesions have completely healed is the preferred regimen. Alternative regimens include [[doxycycline]], [[ciprofloxacin]], [[erythromycin]], and [[trimethoprim-sulfamethoxazole]]. Pregnant women should be treated with erythromycin. Sexual partners should also be evaluated and treated.


==Medical Therapy==
==Medical Therapy==
*All patients with donovanosis and their sexual partners (within 60 days) should be evaluated and treated with antimicrobial therapy.<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459  }} </ref>
*A limited number of studies on donovanosis treatment have been published.
*A limited number of studies on Donovanosis treatment have been published.<ref name="pmid12473810">{{cite journal| author=O'Farrell N| title=Donovanosis. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 6 | pages= 452-7 | pmid=12473810 | doi= | pmc=PMC1758360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12473810  }} </ref>
*Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers.
 
*Healing typically proceeds inward from the ulcer margins.
*Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers.<ref name="pmid12473810">{{cite journal| author=O'Farrell N| title=Donovanosis. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 6 | pages= 452-7 | pmid=12473810 | doi= | pmc=PMC1758360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12473810  }} </ref>
*Relapse can occur 6–18 months after apparently effective therapy.
 
*Healing typically proceeds inward from the ulcer margins. Relapse can occur 6–18 months after apparently effective therapy.<ref name="pmid12473810">{{cite journal| author=O'Farrell N| title=Donovanosis. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 6 | pages= 452-7 | pmid=12473810 | doi= | pmc=PMC1758360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12473810  }} </ref>
 
*Several antimicrobial regimens have been effective, but a limited number of controlled trials have been published.<ref name="pmid12473810">{{cite journal| author=O'Farrell N| title=Donovanosis. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 6 | pages= 452-7 | pmid=12473810 | doi= | pmc=PMC1758360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12473810  }} </ref>
*Several antimicrobial regimens have been effective, but a limited number of controlled trials have been published.<ref name="pmid12473810">{{cite journal| author=O'Farrell N| title=Donovanosis. | journal=Sex Transm Infect | year= 2002 | volume= 78 | issue= 6 | pages= 452-7 | pmid=12473810 | doi= | pmc=PMC1758360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12473810  }} </ref>


===Antimicrobial Therapy===
===Antimicrobial Therapy===
* '''Donovanosis'''<ref name="CDC">2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/donovanosis.htm Accessed March 03 2016</ref>
*Preferred regimen: [[Azithromycin]] 1 g PO once per week for at least 3 weeks and until all lesions have completely healed<ref name="CDC">2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/donovanosis.htm Accessed March 03 2016</ref>
:*Preferred regimen: [[Azithromycin]] 1 g PO once per week for at least 3 weeks and until all lesions have completely healed
*Alternative regimen (1): [[Doxycycline]] 100 mg PO bid for at least 3 weeks and until all lesions have completely healed
:*Alternative regimen (1): [[Doxycycline]] 100 mg PO bid for at least 3 weeks and until all lesions have completely healed
*Alternative regimen (2): [[Ciprofloxacin]] 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
:*Alternative regimen (2): [[Ciprofloxacin]] 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
*Alternative regimen (3): [[Erythromycin]] base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
:*Alternative regimen (3): [[Erythromycin]] base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
*Alternative regimen (4): [[Trimethoprim-sulfamethoxazole]] one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed
:*Alternative regimen (4): [[Trimethoprim-sulfamethoxazole]] one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed
:*Note: The addition of an [[Aminoglycoside]] (e.g., [[Gentamicin]] 1 mg/kg IV q8h) to these regimens can be considered if improvement is not evident within the first few days of therapy.
:* Note (1): The addition of an [[Aminoglycoside]] (e.g., [[Gentamicin]] 1 mg/kg IV q8h) to these regimens can be considered if improvement is not evident within the first few days of therapy.
===Special Considerations===
:* Note (2): Individuals who have had sexual contact with a patient diagnosed with donovanosis within the past 60 days prior to the onset of the patient's symptoms should also be examined and offered therapy. However, the value of empiric therapy in the absence of clinical signs and symptoms has not been established.
*'''Pregnancy''': Doxycycline, ciprofloxacin and sulfonamides are contraindicated among pregnant women. Pregnant and lactating women should be treated with the erythromycin or azithromycin regimen, and consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin).
:* Note (3): Doxycycline and ciprofloxacin are contraindicated among pregnant women. Pregnancy is a relative contraindication to the use of sulfonamides. Pregnant and lactating women should be treated with the erythromycin regimen, and consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin). Azithromycin might prove useful for treating donovanosis during pregnancy, but published data is lacking.
*'''HIV coinfection''': Individuals with both donovanosis and HIV infection should receive the same regimens as those who are HIV-negative; however, the addition of a parenteral aminoglycoside (e.g., gentamicin) can also be considered.<ref name="CDC">2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/donovanosis.htm Accessed March 03 2016</ref>
:* Note (4): Individuals with both donovanosis and HIV infection should receive the same regimens as those who are HIV-negative; however, the addition of a parenteral aminoglycoside (e.g., gentamicin) can also be considered.


===Follow-Up===
===Follow-Up===
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Persons who have had sexual contact with a patient who has granuloma inguinale within the 60 days before onset of the patient’s symptoms should be examined and offered therapy.
Persons who have had sexual contact with a patient who has granuloma inguinale within the 60 days before onset of the patient’s symptoms should be examined and offered therapy.
*Note: the value of empiric therapy in the absence of clinical signs and symptoms has not been established.<ref name="CDC"></ref>
*Note: the value of empiric therapy in the absence of clinical signs and symptoms has not been established.<ref name="CDC"></ref>
==Surgical Care==
Surgery may be necessary to correct [[elephantiasis]], [[strictures]], or [[fistulae]].


==References==
==References==
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[[Category:Sexually transmitted infections]]
[[Category:Sexually transmitted infections]]
[[Category:Bacterial diseases]]
[[Category:Bacterial diseases]]
[[Category:Infectious disease]]
 
[[Category:Disease]]
[[Category:Disease]]


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Latest revision as of 17:36, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]; Nate Michalak, B.A.

Overview

Antimicrobial therapy is the mainstay of treatment for donovanosis. Azithromycin 1 g PO once per week for at least 3 weeks and until all lesions have completely healed is the preferred regimen. Alternative regimens include doxycycline, ciprofloxacin, erythromycin, and trimethoprim-sulfamethoxazole. Pregnant women should be treated with erythromycin. Sexual partners should also be evaluated and treated.

Medical Therapy

  • A limited number of studies on donovanosis treatment have been published.
  • Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers.
  • Healing typically proceeds inward from the ulcer margins.
  • Relapse can occur 6–18 months after apparently effective therapy.
  • Several antimicrobial regimens have been effective, but a limited number of controlled trials have been published.[1]

Antimicrobial Therapy

  • Preferred regimen: Azithromycin 1 g PO once per week for at least 3 weeks and until all lesions have completely healed[2]
  • Alternative regimen (1): Doxycycline 100 mg PO bid for at least 3 weeks and until all lesions have completely healed
  • Alternative regimen (2): Ciprofloxacin 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
  • Alternative regimen (3): Erythromycin base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
  • Alternative regimen (4): Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed
  • Note: The addition of an Aminoglycoside (e.g., Gentamicin 1 mg/kg IV q8h) to these regimens can be considered if improvement is not evident within the first few days of therapy.

Special Considerations

  • Pregnancy: Doxycycline, ciprofloxacin and sulfonamides are contraindicated among pregnant women. Pregnant and lactating women should be treated with the erythromycin or azithromycin regimen, and consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin).
  • HIV coinfection: Individuals with both donovanosis and HIV infection should receive the same regimens as those who are HIV-negative; however, the addition of a parenteral aminoglycoside (e.g., gentamicin) can also be considered.[2]

Follow-Up

Patients should be followed clinically until signs and symptoms resolve.[2]

Treatment of Sex Partners

Persons who have had sexual contact with a patient who has granuloma inguinale within the 60 days before onset of the patient’s symptoms should be examined and offered therapy.

  • Note: the value of empiric therapy in the absence of clinical signs and symptoms has not been established.[2]

Surgical Care

Surgery may be necessary to correct elephantiasis, strictures, or fistulae.

References

  1. O'Farrell N (2002). "Donovanosis". Sex Transm Infect. 78 (6): 452–7. PMC 1758360. PMID 12473810.
  2. 2.0 2.1 2.2 2.3 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/donovanosis.htm Accessed March 03 2016


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