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.[1]


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

[2]

Donovanosis Treatment
Preferred Regimen
Doxycycline 100 mg po bid x 3–4 weeks
Alternative Regimen
TMP-SMXDS q12h x 3 weeks
OR
Ciprofloxacin 750 mg po bid x 3 weeks
OR
Azithromycin 1 gm po qweek x 3 weeks
OR
Erythromycin 500 mg po qid x 3 weeks
Pathogens Preferred Treatment Duration of Treatment Alternative Treatment
Klebsiella granulomatis Doxycycline

100 mg orally twice a day

For at least 3 weeks and until all lesions have completely healed Azithromycin

1 g orally once per week for at least 3 weeks and until all lesions have completely healed

OR

Ciprofloxacin

750 mg orally twice a day for at least 3 weeks and until all lesions have completely healed

OR

Erythromycin base

500 mg orally four times a day for at least 3 weeks and until all lesions have completely healed

OR

Trimethoprim-sulfamethoxazole

one double-strength (160 mg/800 mg) tablet orally twice a day for at least 3 weeks and 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

  1. O’Farrell N. Donovanosis. Sex Transmit Infect 2002;78:452–7.
  2. http://www.cdc.gov/std/treatment/2010/genital-ulcers.htm#genulc4


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