Donovanosis medical therapy: Difference between revisions

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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==
*A limited number of studies on Donovanosis treatment have been published.
*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.
*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.
*Healing typically proceeds inward from the ulcer margins.
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:*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: 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===
===Special Considerations===
*'''Pregnancy''': 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.
*'''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.<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>
*'''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>


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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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