Donovanosis medical therapy

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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]

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.

Shown below is a table summarizing the preferred and alternative empiric treatment for Donovanosis.

Anti microbial regimen

• 1.Granuloma Inguinale (Donovanosis)

Donovanosis Treatment Preferred Regimen ▸ Azithromycin 1 g PO once a week or 500 mg qd for 3 weeks THEN until all lesions have completely healed Alternative Regimen ▸ Doxycycline 100 mg PO bid for 3 weeks THEN until all lesions have completely healed OR ▸ Ciprofloxacin 750 mg po bid x 3 weeks OR ▸ Erythromycin base 500 mg PO qid for at least 3 weeks THEN until all lesions have completely healed OR ▸ Trimethoprim-sulfamethoxazole DS (160 mg/800 mg) tablet PO bid for at least 3 weeks THEN until all lesions have completely healed

Therapy should be continued at least 3 weeks and until all lesions have completely healed. Some specialists recommend the addition of an aminoglycoside (e.g., gentamicin 1 mg/kg IV every 8 hours) to these regimens if improvement is not evident within the first few days of therapy

Management 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. However, the value of empiric therapy in the absence of clinical signs and symptoms has not been established.

Special Considerations

Pregnancy

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 granuloma inguinale during pregnancy, but published data are lacking. Doxycycline and ciprofloxacin are contraindicated in pregnant women.

HIV Infection

Persons with both granuloma inguinale and HIV infection should receive the same regimens as those who are HIV negative. Consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin).

References

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