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DESCRIPTION
Granuloma Inguinale (Donovanosis) is a Gram-negative bacterial (Calmmatobacterium granulomatis) sexually transmitted disease generally affecting people living in tropical climates. This disease is commonly found in areas such as Southeast India, Guyana, and New Guinea, but it occurs on occasion in the United states. It is becoming more common in the U.S., especially in the south, southeast and southwest regions.
Incubation period is 8 to 12 weeks. Because of the scarcity of medical treatment, the disease often goes untreated. Men are affected more than twice as often as women, with most infections occurring in people aged 20 to 40 years. The disease is seldom seen in children or the elderly.
It is thought that anal intercourse, rather than vaginal intercourse, is the most frequent source of infection. About 50 percent of infected men and women have lesions in the anal area.
The disease is characterized by painless genital ulcers which can be mistaken for syphilis. However, they ultimately progress to destructive nature of Donovanosis and also increases the risk of superinfection by other pathogenic microbes.
CLASSIFICATION INFORMATION
The proper clinical designation for Donovanosis is Granuloma Inguinale. Granuloma is a nodular type of inflammatory reaction, and inguinale refers to the inguinal region, which is commonly involved in this infection. The disease is commonly known as Donovanosis, after the Donovan Bodies which are a diagnostic sign. Discovered by a researcher named Donovan, these intracellular inclusions represent bacteria that have been engulfed by scavenger cells called mononuclear phagocytes or histiocytes.
The causative organism, Klebsiella granulomatis, used to be called Calymmatobacterium granulomatis, from the Greek kalymma (a hood or veil), referring to the lesions that contain the bacteria. Prior to this it was called Donovania granulomatis, named after the Donovan Bodies. The species name granulomatis refers to the granulomatous lesions. The organism was recently reclassified under the genus Klebsiella, a drastic taxonomic change, since it involved changing the organism's phylum. However, polymerase chain reaction (PCR) techniques using a colorimetric detection system showed a 99% similarity with other species in the Klebsiella genus.
FREQUENT SIGNS & SYMPTOMS
Formation of a small, beefy-red, painless lesion (cyst, papule, or nodule) in the genital area that does not readily heal. These nodules appear after about 10 to 40 days after the contact with the bacteria. It gradually eats away the skin and forms an elevated, beefy-red, velvety nodule (granulation tissue). Later, this lesion or lesions ulcerates (becomes open, fleshy and runny oozing lesions) and may spread, mutilating the infected tissue so that it involves most of the vulva, and sometimes the buttocks and lower abdomen.
The lesions occur at the region of contact, typically found on the shaft of the penis, the labia, or the perianal region. Rarely, the vaginal wall or cervix is the site of the lesion.
Marked discomfort occurs if the ulceration spreads to the urethra or anal area. Walking, sitting and sexual intercourse become painful.
Spread of the disease to the inguinal folds (where the legs meet the torso).
Vaginal discharge that has an unpleasant odor.
Nodules are usually painless and bleed easily if traumatized.
Depigmentation (loss of skin color) of the genitals and surrounding skin.
If left untreated, the disease results in mutilation and destruction of the genital tissue.
In its early stages, it may be difficult to differentiate granuloma inguinale from chancroid. In the later stages, granuloma inguinale may resemble advanced genital cancers, lymphogranuloma venereum, and anogenital cutaneous amebiasis.
CAUSES
An organism, Calymmatobacterium granulomatis (Donovan body), that is spread via sexual intercourse with an infected person.
The microorganism spreads from one host to another through contact with the open sores. Oral, vaginal, or anal intercourse are high risk behaviors to engage in with someone who is infected.
RISK INCREASES WITH
Multiple sexual partners.
Unprotected sexual intercourse.
Infection with other sexually transmitted diseases.
PREVENTIVE MEASURES
Monogamous sexual relationship with an uninfected person.
Sexual contact with people living in tropical and subtropical climates increases the likelihood of exposure.
Safe sex practices will prevent the spread of granuloma inguinale as well as other sexually transmitted diseases and will also prevent unwanted pregnancies. Having the male partner use a latex condom.
Cleansing of the genital area before and after sexual encounters. Douching is usually not effective.
If there has been possibility of exposure, seek medical care immediately. Early treatment may head off the infection.
The disease is effectively treated with antibiotics, therefore, developed countries, like the United States, have a very low incidence of Donovanosis, (approximately 100 cases reported each year in the United States.) However, sexual contacts with individuals in endemic regions dramatically increases the risk of contracting the disease. Avoidance of these sexual contacts, and STD testing before beginning a sexual relationship are effective preventative measures for Donovanosis.
EXPECTED OUTCOME
With treatment, healing should begin within a week, but complete resolution will take up to 3 weeks.
Treating this disease early decreases the chances of tissue destruction or scarring. Untreated disease can lead to complications.
POSSIBLE COMPLICATIONS
Secondary bacterial infection.
Relapse my occur if treatment is stopped too soon.
Scars may form where infection occurred.
Destruction of genital tissue.
Genital depigmentation (loss of skin color).
Permanent genital swelling from lymphatic scarring.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
The patient's sexual history is requested. Experienced health care providers are able to diagnose Donovanosis by only looking at the ulcers. However, it may be necessary for the health care provider to take a sample of tissue to correctly diagnose the disease.
Classically, the diagnosis of granuloma inguinale should be considered if genital lesions have been present for a long time and have been progressively enlarging. Serological tests such as that used to detect syphilis are available only on a research basis for diagnosing granuloma inguinale.
Diagnosis is confirmed with laboratory studies of scrapings or biopsies of the lesions. Wright-Giesmsa stain may be added to the sample in order to better view the cells. Additionally, the presence of Donovan bodies in the tissue sample confirms Donovanosis.
Culture of tissue sample is difficult to do and not routinely available.
Testing (screening) for other sexually transmitted diseases is often recommended.
CONVENTIONAL MEDICAL TREATMENT
Treatment is with medication. Three weeks of treatment with erythromycin, streptomycin, or tetracycline, or 12 weeks of treatment with ampicillin are standard forms of therapy. Normally, the infection will begin to subside within a week of treatment, however, the full treatment period must be followed in order to minimize the possibility of relapse.
Sitz baths frequently relieve soreness. Sit in a tub of hot water for 10 to 15 minutes. Repeat baths as often as 3 or 4 times a day. See Sitz Baths for more information.
Sexual partners should be examined for infection.
A follow-up medical examination after treatment is important to verify that healing is complete.
Additional information is available from the Sexually Transmitted Diseases Hotline (800) 227-8922.
MEDICATION
An antibiotic, such as tetracycline, may be prescribed. A complete cure of granuloma inguinale requires fairly long treatment. Most treatment courses run 3 weeks or until the lesions have completely healed. Do not discontinue medicine until healing is complete or when advised to by your health care provider.
The antibiotics used include:
- Tetracycline or doxycycline
- Sulfamethoxazole
- Gentamicin
- Streptomycin
- Ciprofloxacin
- Erythromycin
A follow-up examination is essential because the disease can reappear after an apparently successful cure.
ACTIVITY
Avoid sexual intercourse during the active phase of the infection.
DIET
No dietary restrictions. Eat a well-balanced diet to maintain a healthy immune system. If taking tetracycline, avoid dairy products within 3 hours of taking the medication.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of granuloma inguinale.
Symptoms worsen despite treatment.
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
BENEFICIAL DIETARY SUPPLEMENTS FOR VENEREAL DISEASES
Astragalus protects the immune system.
Herbal Remedies: Astragalus Root, Nature's Way, 470 mg, 180 VCaps
Butchers Broom shrinks swollen lymph nodes.
Herbal Remedies: Butchers Broom Tincture, 2 fl. oz.
Acidophilus is effective in maintaining "good" bacteria in the body during antibiotic use.
Herbal Remedies: Acidophilus Supplement Powder, Non-Dairy, 3 oz. Bulk
Herbal Remedies: Acidophilus, 3 Billion, NOW Foods, 90 Tabs
Herbal Remedies: Lactobacillus Acidophilus Supplement, Non-Dairy, 100 Caps
Herbal Remedies: Lactobacillus Acidophilus, Kosher Liquid, All Natural, Vegetarian Medium, Lactose Free, Apple Strawberry Flavor, Dynamic Health, 16 fl. oz.
Herbal Remedies: Kyo-Dophilus, Wakunaga Kyolic, 180 Caps
VENEREAL DISEASE SUPPLEMENTS & PRODUCTS
Supplements and products for venereal diseases (VD) (From Venus, Goddess of love in Roman mythology), sexually transmitted diseases (STD) that are passed on during sexual intercourse or other intimate contact with the sex organs. The two most common types of STDs are gonorrhea and syphilis. However there are many other STDs. They include chancroid, lymphogranuloma venereum, granuloma inguinal, genital herpes, chlamydia, trichomoniasis, candidiasis, genital worts, AIDS., See specific sexually transmitted disease for specific descriptions and treatments.
Astragalus Root, Nature's Way, 470 mg, 180 VCaps
Astragalus root is considered to have a normalizing effect on the body's functions. Astragalus is an important herb in Chinese medicine and is commonly included in Chinese cuisine.Butchers Broom, 2 fl. oz.
Butchers Broom is a laxative and diuretic and it is also used to improve circulation problems, hemorrhoids, varicose veins, arteriosclerosis, and blood clots.Clove Oil (Eugenia Caryophyllata), 100% Pure Essential Oil, NOW Foods, 1 fl. oz.
Clove oil, although primarily used in aromatherapy, can be used externally or internally for various uses.Clove Powder (Caryophyllus Aromaticus), 4 oz. Bulk
Today in America Clove is used to treat worms, viruses, candida, and various bacterial and protozoan infections, but is most commonly used externally to treat toothache and mouth and throat inflammation and to slow macular degeneration.Cloves, 500 mg, 100 Caps
Cloves are used against parasites, flatulence, and nausea. Eating cloves is considered to be an aphrodisiac. Use as a dietary supplement or put directly on tooth for a toothache. Contains only freshly ground clove.Cure For HIV & AIDS, By Hulda Clark, Ph.D., N.D.
This book posits that the human intestinal fluke, a parasite, is the source of the HIV virus. Dr. Clark provides exact instructions for their cure, documented with 70 case histories.Food Grade Diatomaceous Earth (DE) Powder, 8 oz.
This Food Grade Diatomaceous Earth is safe and nontoxic and destroys intestinal parasites physically by injuring them.Grapefruit Seed Extract, By Louise Tenney, M.H.
Used for everything from the common cold to ringworm, grapefruit seed extract could represent a viable alternative to antibiotics and other medicines.Hulda Clark's Parasite Cleansing Protocol, 20 Day Kit, Parasite Cleansing Program With Black Walnut Green-Hull, 300 mg, 50 Caps
This Parasite Cleansing Kit, Hulda Clark's Parasite Cleanse Protocol, is a complete kit for the natural removal of Parasites from the body within 20 days.Hulda Clark's Parasite Cleansing Protocol, 20 Day Kit, Parasite Cleansing Program With Black Walnut Green-Hull Tincture, 1 fl. oz.
This is a complete Parasite Removal kit with Black Walnut Green Hull Tincture, Wormwood Capsules, Clove Capsules and a Complete Guide on Parasite Removal for Adult, Children and Pet Program.Neem Detoxification, Banyan Botanicals, 90 Tabs
Neem has traditionally been used to purify the blood, cleanse the liver and support the immune system. It is also commonly used for a variety of skin irritations and inflammations, and to support healthy blood glucose levels.Neem Oil, Pure Cold-Pressed Seed, Solvent Free, 1 oz.
Neem works as an effective insecticide against wool moths, ants, termites, fleas and sand fleas, as well as flying mosquitoes and their larvae. It is considered completely non toxic to humans, pets and livestock.Nutribiotic Grapefruit Seed Extract Plus, 125 mg, 90 Caps
NutriBiotic Grapefruit Seed Extract Plus Capsules contain 125 mg of grapefruit seed extract, equivalent to 12-15 drops of NutriBiotic GSE liquid concentrate, combined with the extracts of echinacea and artemisia annua.Olive Leaf Extract, By, Dr. Morton Walker
Olive leaf extract has vast healing powers that have been found to eliminate the viruses, fungi, bacteria and other parasites that cause disease.Parasite Menace, By Dr. Skye Weintraub, N.D.
This book tells which are the most common parasites and how to prevent, treat and eliminate parasitic infection.Parasites: The Enemy Within, By Rev. Hanna Kroeger, MsD
This Book Addresses the problem of parasites with the whole person in mind. Includes some forms of detoxification and nutritional rebuilding.Parastroy 2-Part Natural Parasite Clease, Includes 2 Free CD's, Nature's Secret, 180 Caps
Formulated from successful clinical experience, Parastroy Parasite Cleanse is a two-part program that supports the body's immune system, and creates an environment that is unfriendly to parasites.Pau D'Arco Bark Powder (Tabebuia Impetiginosa), 4 oz. Bulk
Pau d'arco bark is a rich source of iron, which contributes to the elimination of wastes from the body and the assimilation of nutrients.Samento Liquid Extract, Uncaria Tomentosa, 0.5% POA, 1 fl. oz.
Samento Uncaria Tomentosa is a Cat's Claw herb that may be beneficial in supporting the treatment of a wide range of immune system related conditions. Immune disorders may be the cause for various conditions such as cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.Samento, Uncaria Tomentosa, Extra Strength, 100 Times More Effective Than Regular Cat's Claw!, 0.5% POA, 600 mg, 30 Caps
Samento is beneficial in supporting the treatment of a wide range of immune system related conditions; these include but are not limited to cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.Scabies & Parasites Formula Tincture, 2 fl. oz.
The Scabies and Parasites Tincture can be used for both internal and external use to help rid the body of parasites, scabies, and ringworm.Shea Butter: The Nourishing Properties of Africa's Best-Kept Natural Beauty Secret, By W.G. Goreja
Shea has been part of Africa's ancient healing systems for many thousands of years to control parasites among many other health applications; better yet, shea is completely natural.The Cure For All Diseases, Book By Dr. Hulda Regehr Clark
No diabetes, no high blood pressure, no cancer, no HIV/AIDS, no migraines, no lupus and so on! Not a single disease is left unconquerable with this new understanding!TheraClear Anti Parasite Formula, 120 Caps
A regular natural detoxification program including TheraClear Anti Parasite Formula and a colon cleanser to promote proper elimination has been recommended by various naturopaths.Vidanga Fruit Powder, Certified Organic, Banyan Botanicals, 1/2 lb.
Certified Organic Vidanga Fruit Powder (Embelia Ribes) Considered one of the best Ayurvedic herbs for eliminating intestinal worms and other parasites.Wild Oregano Oil, California Natural, 1 oz.
Oregano Oil is known as one nature's most powerful anti-fungal and anti-viral herbs. Its natural anti-septic properties make it excellent for killing off parasites and maintaining a healthy immune system.Wild Oregano Oil, California Natural, 510 mg, 90 Caps
Oregano Oil is known as one nature's most powerful anti-fungal and anti-viral herbs. Its natural anti-septic properties make it excellent for killing off parasites and maintaining a healthy immune system.
Herbal Remedies: Venereal Disease Supplements & Products
MoonDragon's ObGyn Information: Sexually Transmitted Diseases (STDs)
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Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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