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Emerg Med Clin North Am 2019 May;37(2):165-192

Prisma Health, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC 29605, USA. Electronic address:

Sexually transmitted diseases (STDs) continue to be underrecognized leading to devastating health and economic consequences. Emergency clinicians play an important role in diagnosing and managing STDs and in improving health care outcomes for both the patient and their partners. In addition, antibiotic resistance and emerging infections continue to challenge providers in clinical practice. Read More

Hautarzt 2018 Nov;69(11):945-959

Department of Dermatology, Preah Kossamak-Hospital, BP 1006, Phnom Penh, Kambodscha.

Sexually transmitted infections (STI) are common all over the world and the incidence of chlamydia, gonorrhea, syphilis and trichomoniasis alone is estimated at 500 million/year. Of these infections 75% occur in tropical countries in Latin America, sub-Saharan Africa and South as well as Southeast Asia. The bacterial infections chancroid, lymphogranuloma venereum (LGV) and granuloma inguinale (GI, Donovanosis) are termed tropical STI. Read More

An Bras Dermatol 2018 Jul-Aug;93(4):592-594

Laboratory of Pathology, Santa Casa de São Paulo, São Paulo (SP), Brazil.

Donovanosis is a chronic infectious disease caused by the Gram-negative bacteria Klebsiella granulomatis, which mainly affects the skin and mucous membranes of the genital, perigenital, and inguinal regions. Also known as venereal granuloma or granuloma inguinale, it is endemic in tropical and subtropical regions of the globe and often associated with sexual transmission. We report the case of an 11-year-old female victim of chronic sexual abuse, who was diagnosed with donovanosis and presented a good therapeutic response to doxycycline. Read More

Indian J Dermatol 2017 Nov-Dec;62(6):630-634

Department of Dermatology, Bankura Sammilani Medical College, Bankura, West Bengal, India.

Introduction: Treatment of sexually transmitted infections (STIs) has been made easy for field workers due to syndromic approach. The etiological agent responsible for different STI syndromes needs to be validated from time to time so as to guide the therapeutic regimen.

Aims And Objectives: The aim of this study was to evaluate the etiological agent for STI syndromes and correlate the syndromic diagnosis with etiological diagnosis. Read More

J Clin Diagn Res 2016 Dec 1;10(12):PD05-PD06. Epub 2016 Dec 1.

Professor, Department of Surgery, Madurai Medical College , Madurai, Tamil Nadu, India .

Tuberculosis (TB) of penis is a very rare entity, even in developing countries. It may present as primary or secondary to Pulmonary TB (PTB). Penile TB mimics carcinoma penis, granulomatous penile ulcer, genital herpes simplex, granuloma inguinale and HIV infection. Read More

Semin Diagn Pathol 2017 May 14;34(3):301-311. Epub 2016 Dec 14.

Section of Dermatopathology, Division of Surgical & Cytological Pathology, University of Virginia Medical Center, Charlottesville, VA, USA. Electronic address:

Granulomas of the skin may be classified in several ways. They are either infectious or non-infectious in character, and they contain areas of necrobiosis or necrosis, or not. Responsible infectious agents may be mycobacterial, fungal, treponemal, or parasitic organisms, and each case of granulomatous dermatitis should be assessed histochemically for those microbes. Read More

Ann Dermatol Venereol 2016 Nov 20;143(11):767-769. Epub 2016 Oct 20.

Service de dermatologie, hôpital Saint-André, CHU, 1, rue Jean-Burguet, 33000 Bordeaux, France.

Ann Dermatol Venereol 2016 Nov 20;143(11):739-740. Epub 2016 Oct 20.

Centre clinique et biologique des MST, hôpital Saint-Louis, 42, rue Bichat, 75010 Paris, France.

Dermatol Online J 2016 Apr 18;22(4). Epub 2016 Apr 18.

School of Medicine, UC Davis.

Granuloma inguinale, or Donovanosis, is a rare, sexually transmitted ulcerative disease primarily affecting the genital area. In this report, we present a case of a 50-year-old man that was diagnosed with granuloma inguinale after a 2-month history of a penile ulcer. Histological analysis demonstrated the presence of Donovan bodies within macrophages, confirming the diagnosis. Read More

Int J STD AIDS 2017 03 20;28(4):411-414. Epub 2016 Aug 20.

1 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Donovanosis is a rare, chronic and indolent sexually transmitted infection caused by Klebsiella granulomatis. The ulcers in donovanosis rarely undergo malignant transformation, which is usually seen in longstanding ulcers. We present a case of a 32-year-old male who presented with a two-month history of rapidly progressive, large, foul-smelling ulcers over the groin, distal penile shaft and scrotum. Read More

Ann Dermatol Venereol 2016 Nov 9;143(11):697-700. Epub 2016 May 9.

Service de dermatologie et de vénérologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France.

Introduction: Donovanosis (granuloma inguinale) is a bacterial infection caused by Klebsiella granulomatis that occurs mainly in the genital area and is primarily sexually transmitted; it is seen predominantly in the tropics. Herein, we report a case of the disease contracted in metropolitan France.

Patients And Methods: A 47-year-old man presented with painless ulceration of the glans, present for one month, with progressive extension; there was no history of any recent trip abroad. Read More

Dis Mon 2016 Aug 20;62(8):306-13. Epub 2016 Apr 20.

Int J STD AIDS 2016 07 15;27(8):605-7. Epub 2016 Feb 15.

Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Norway.

Donovanosis is a rare sexually transmitted infection now mainly seen in sporadic cases in Papua New Guinea, South Africa, India, Brazil and Australia. The causative organism is Calymmatobacterium granulomatis, though a proposal has been put forward that the organism be reclassified as Klebsiella granulomatis comb nov The incubation period is approximately 50 days with genital papules developing into ulcers that increase in size. Four types of lesions are described - ulcerogranulomatous, hypertrophic, necrotic and sclerotic. Read More

Fed Regist 2016 Jan;81(16):4191-206

The Centers for Disease Control and Prevention (CDC), within the Department of Health and Human Services (HHS), is issuing this final rule (FR) to amend its regulations governing medical examinations that aliens must undergo before they may be admitted to the United States. Based on public comment received, HHS/CDC did not make changes from the NPRM published on June 23, 2015. Accordingly, this FR will: Revise the definition of communicable disease of public health significance by removing chancroid, granuloma inguinale, and lymphogranuloma venereum as inadmissible health-related conditions for aliens seeking admission to the United States; update the notification of the health-related grounds of inadmissibility to include proof of vaccinations to align with existing requirements established by the Immigration and Nationality Act (INA); revise the definitions and evaluation criteria for mental disorders, drug abuse and drug addiction; clarify and revise the evaluation requirements for tuberculosis; clarify and revise the process for the HHS/CDC-appointed medical review board that convenes to reexamine the determination of a Class A medical condition based on an appeal; and update the titles and designations of federal agencies within the text of the regulation. Read More

Commun Dis Intell Q Rep 2015 Dec 31;39(4):E584-9. Epub 2015 Dec 31.

Office of Health Protection, Australian Government Department of Health, Canberra, Australian Capital Territory.

Folia Med Cracov 2015 ;55(1):35-41

Department of Dermatology Jagiellonian University Medical College, Skawinska 8, Krakow, Poland.

We analyzed publications and articles in the PubMed database about the use of trimethoprim and sulfamethoxazole (TMP-SMX) in dermatology. Literature published in the English language, at least in the past two decades, was reviewed. Specific dermatologic indications for TMP-SMX are few but it is often used as the second- or third- line agent. Read More

Int Marit Health 2015 ;66(4):238-46

Head of Department of Epidemiology and Tropical Medicine, Military Institute of Medicine, Warsaw, Poland.

Sexually transmitted infections (STIs) are among the most common notifiable health problems worldwide, with particularly high rates in developing countries. Men and women with multiple sexual partners at home or a previous history of STIs are more likely to have casual sexual exposure (CSE) while travelling. Over the last several decades 5% to even 50% of short-term travellers engaged in CSE during foreign trips. Read More

Urol Clin North Am 2015 Nov;42(4):507-18

Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL 60611, USA. Electronic address:

Sexually transmitted infections (STIs) remain a significant burden on public health in the United States. Primary prevention counseling with early diagnosis and treatment remain the best methods to decrease the incidence of STIs. Through significant public heath interventions, the incidence of gonorrhea, Chlamydia, and trichomoniasis is decreasing; however, the incidence of primary and secondary syphilis is increasing. Read More

Scientifica (Cairo) 2015 8;2015:601624. Epub 2015 Sep 8.

Department of Urology, North Manchester General Hospital, Delaunay's Road, Manchester, UK.

Background. Tuberculosis of the penis (TBP) is rare. Aim. Read More

Dermatol Clin 2015 Jul;33(3):595-607

Center for Clinical Studies, 1401 Binz, Suite 200, Houston, TX 77004, USA; Department of Dermatology, University of Texas Health Science Center, 6655 Travis, Suite 600, Houston, TX 77003, USA.

Granulomatous diseases are caused by multiple infectious and noninfectious causes. Deep fungal infections can present in the skin or extracutaneously, most commonly with lung manifestations. An Azole or amphotericin B is the universal treatment. Read More

Lancet 2015 Jun;385(9987):2644

Department of Paediatric Infectious Diseases, King Edward VIII Hospital, KwaZulu-Natal, South Africa.

Int J STD AIDS 2016 Jan 22;27(1):72-4. Epub 2015 Jan 22.

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

Although atypical presentations of herpetic infection in immunocompetent individuals are common, they very rarely have the extensive, chronic and verrucous appearances seen in the immunocompromised host. We report a case of genital herpes manifesting as painless chronic non-healing genital ulcers with exuberant granulation tissue in an immunocompetent man. Owing to this morphology, the ulcers were initially mistaken for donovanosis. Read More

Indian J Sex Transm Dis AIDS 2014 Jan;35(1):56-8

Department of Dermatology, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India.

Granuloma inguinale (GI) is an acquired chronic, slowly progressive, mildly contagious disease of venereal origin, characterized by granulomatous ulceration of the genitalia and neighboring sites, with little or no tendency to spontaneous healing caused by Klebsiella (Calymmatobacterium) granulomatis. A 55-year-old male presented with fissured, foul smelling, fungating growth over prepuce with phimosis mimicking squamous cell carcinoma (SCC) without lymphadenopathy. It started with painless papulonodular showed pseudoepitheliomatous hyperplasia, infiltration in dermis, acanthosis and vacuolated macrophages suggestive of GI and not showing any histopathological features of SCC. Read More

J Dtsch Dermatol Ges 2014 Jun;12(6):451-63

Ruhr-Universität Bochum, Clinic for Dermatology, Venerology and Allergology.

In no other medical field former rare infections of the 1980(th) and 1990(th) occur again as this is seen in the field of venerology which is as well based on the mobility of the population. Increasing rates of infections in Europe, and increasing bacteriological resistances face health professionals with new challenges. The WHO estimates more than 340 million cases of illnesses worldwide every year. Read More

Clin Dermatol 2014 Mar-Apr;32(2):290-8

University Hospital Center Zagreb, Department of Dermatology and Venereology, School of Medicine University of Zagreb, HR-10000 Zagreb, Croatia. Electronic address:

Chancroid, lymphogranuloma venereum, and granuloma inguinale may be considered as tropical venereal diseases. These diseases were a major diagnostic and therapeutic challenge in past centuries. Currently, patients with these bacterial infections that are endemic to the tropics occasionally consult with dermatologists in temperate climates. Read More

Int J STD AIDS 2014 Oct 19;25(12):894-7. Epub 2014 Feb 19.

Deparment of Pathology, Maulana Azad Medical College and Associated Hospital, New Delhi, India.

Donovanosis causes granulomatous ulceration of genitalia and neighbouring sites with little tendency to heal spontaneously. It is uncommonly seen nowadays in sexually transmitted infection clinics of north India. The present case is reported for its scarcity and to make clinicians aware of this disease which may rarely accompany carcinoma. Read More

Gastroenterol Clin North Am 2013 Dec 18;42(4):877-92. Epub 2013 Oct 18.

Department of Colon and Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.

Sexually transmitted diseases (STDs) are common and they can involve the anus and rectum in both men and women. In this article, the main bacterial and viral STDs that affect the anus and rectum are discussed, including their prevalence, presentation, and treatment. Read More

Prim Care 2013 Sep 29;40(3):557-87. Epub 2013 Jun 29.

University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases, remain a growing worldwide problem and public health issue. This article covers the epidemiology of STIs, the history and physical findings, screening guidelines, and the general plan to combat STIs. Prevention is discussed using the latest information from the Centers for Disease Control and Prevention and other references. Read More

Bull Soc Pathol Exot 2013 Aug 8;106(3):153-5. Epub 2013 Jun 8.

CH Montauban, médecine Interne, pathologies infectieuse et tropicales, 100, rue Léon Cladel, 82000 Montauban, France.

An ongoing lymphogranuloma venereum (LGV) outbreak has been reported in several European countries since 2003, related to a new variant L2b. This serovar appears to affect men who have sex with men (MSM), most of them being co-infected with the Human Immunodeficiency Virus (HIV). The secondary stage of LGV may involve lymph nodes and the inguinal form has sometimes been described on each side of the inguinal ligament thus named the "groove sign". Read More

Am J Dermatopathol 2012 Dec;34(8):818-21

Department of Anatomical Pathology, School of Laboratory Medicine & Medical Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa †National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa.

Two infants, 6 months and 4 months of age, presented with bilateral or unilateral external auditory canal polyps and otorrhea, respectively. Additional findings on examination included otitis media and mastoiditis. Tympanic membrane perforation was noted in one patient and a postauricular abscess in the other. Read More

Int J STD AIDS 2012 Nov;23(11):835-6

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Sciences and Research Chandigarh, Chandigarh, India.

Genital elephantiasis is a disease that is characterized by massive enlargement of the genitalia. Early aetiological diagnosis is of paramount importance so that development of genital elephantiasis can be prevented; otherwise it is not completely reversible with medical therapy and often requires surgical intervention. Chronic mental distress and disability can result as it interferes with daily/routine activities of the affected individual. Read More

Intern Med 2012 1;51(17):2479-81. Epub 2012 Sep 1.

Dermatology Department, Ministry of Health, Etlik Ihtisas Training and Research Hospital, Turkey.

A 46-year-old man complained of ulcerovegetative lesions in the anogenital region, which he had noted one month prior to presentation. The patient had a history of travel to African countries. Therefore, the ulcerovegetative lesions of the patient were suspected to be granuloma inguinale (GI). Read More

Cytojournal 2012 29;9:15. Epub 2012 Jun 29.

Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Rare entities in the Pap test, including neoplastic and non-neoplastic conditions, pose challenges due to their infrequent occurrence in the daily practice of cytology. Furthermore, these conditions give rise to important diagnostic pitfalls. Infections such as tuberculosis cervicitis may be erroneously diagnosed as carcinoma, whereas others, such as schistosomiasis, are associated with squamous cell carcinoma. Read More

J Pediatr Adolesc Gynecol 2012 Aug;25(4):e81-3

Department of Mother and Infant Sciences, University of Milan, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Background: Donovanosis is a chronic bacterial illness, progressive and indolent, which normally attacks the skin and mucous membranes in the genital and perigenital regions.

Case: An 18-year-old pregnant female presented with large, hypertrophic lesions in the ano-genital region. HIV serology was negative. Read More

Am Fam Physician 2012 Feb;85(3):254-62

Georgetown University/Providence Hospital Family Medicine Residency Program, Washington, DC, USA.

Herpes simplex virus infection and syphilis are the most common causes of genital ulcers in the United States. Other infectious causes include chancroid, lymphogranuloma venereum, granuloma inguinale (donovanosis), secondary bacterial infections, and fungi. Noninfectious etiologies, including sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions, can also lead to genital ulcers. Read More

Ann N Y Acad Sci 2011 Aug;1230:E1-E10

Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.

Haemophilus ducreyi and Klebsiella (Calymmatobacterium) granulomatis are sexually transmitted bacteria that cause characteristic, persisting ulceration on external genitals called chancroid and granuloma inguinale, respectively. Those ulcers are endemic in developing countries or exist, as does granuloma inguinale, only in some geographic "hot spots."H. Read More

West Indian Med J 2011 Mar;60(2):137-40

Department of Obstetrics and Gynaecology, The University of the West Indies, Kingston, Jamaica.

Sexually transmitted genital ulcerative conditions are declining in Jamaica. The rates at present are far lower than that seen in the 1950s-1960s. Review of the records of the national Comprehensive Clinic has revealed that all of the major sexually transmitted conditions (Syphilis, Lymphogranuloma Venereum (LGV), Chancroid, Granuloma Inguinale and Herpes Simplex) have declined but have had three peaks between 1958 and 2000. Read More

An Bras Dermatol 2011 May-Jun;86(3):585-6

STD outpatient clinic, Clinics Hospital, Federal University of Pernambuco (PE), Brazil.

The authors present images of two of the most common clinical forms of granuloma inguinale (donovanosis) in males and females. Donovanosis is considered a sexually transmitted disease that is endemic in tropical and subtropical regions of the world. Two microscopic images are also shown, one of a direct smear (the presence of Donovan bodies within large mononuclear cells identified using Giemsa stain) and the other of typical histological findings (rod-shaped Donovan bodies within a mononuclear histiocyte). Read More

J Ayub Med Coll Abbottabad 2011 Jul-Sep;23(3):110-4

Department of Dermatology, Shaheed Muhtarma Benazir Bhutto Medical University Larkana, Pakistan.

Background: Sexually transmitted infections (STIs) are widespread in Pakistan and have not been fully documented particularly in Sindh Province. The aim of this study is to determine the number and clinical pattern of various types of STIs in general population of Larkana division and its surrounding cities.

Methods: A hospital based prospective study was carried out at Male-STD-Clinic in the Department of Dermatology, Shaheed Muhtarma Benazir Bhutto Medical University Hospital Larkana from January 2000 to December 2009. Read More

Sex Transm Dis 2011 Jun;38(6):522-7

Payer Solutions, IMS Health, Woodland Hills, CA, USA.

Background: The Centers for Disease Control strongly recommends HIV screening for all patients who present to health care settings with sexually transmitted diseases (STD) or blood-borne pathogens exposure. The objective of this study is to assess the rates and determinants of HIV screening in a national sample of commercially insured patients screened or diagnosed with an STD or hepatitis B or C.

Methods: We used Poisson regression model with a robust error variance to assess the determinants of HIV screening using administrative claims data from health plans across 6 states (n = 270,423). Read More

Leuk Res 2011 May 4;35(5):e44-5. Epub 2011 Feb 4.

Int J STD AIDS 2010 Sep;21(9):609-10

Ealing Hospital, London, UK.

Donovanosis is a rare sexually transmitted infection now mainly seen in sporadic cases in Papua New Guinea, South Africa, India, Brazil and Australia. The causative organism is Calymmatobacterium granulomatis though a proposal has been put forward that the organism be reclassified as Klebsiella granulomatis comb. nov. Read More

J Med Case Rep 2010 18;4:369. Epub 2010 Nov 18.

Department of Surgery, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi, India.

Introduction: Elephantiasis as a result of chronic lymphedema is characterized by gross enlargement of the arms, legs or genitalia, and occurs due to a variety of obstructive diseases of the lymphatic system. Genital elephantiasis usually follows common filariasis and lymphogranuloma venereum. It may follow granuloma inguinale, carcinomas, lymph node dissection or irradiation and tuberculosis but this happens rarely. Read More

Dermatol Clin 2010 Oct;28(4):765-77

Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, University of Ottawa, Ontario, Canada.

Vulvar edema is associated with a variety of conditions. The edema can result from inflammatory conditions, infections, infestations, trauma, pregnancy, tumors and iatrogenic causes. At times, it is difficult to determine the cause of the vulvar edema. Read More

Braz J Infect Dis 2008 Dec;12(6):521-5

Division of Dermatology, Campinas University, Campinas, SP, Brazil.

Donovanosis is a chronic bacterial illness frequently associated with sexually transmitted infections (STI) and is under diagnosed both in endemic areas as well as in countries in which doctors have little experience with tropical diseases. The utilization of syndromic diagnosis and treatment of STIs in various parts of the world and the previous use of antibiotics make it difficult to find Donovan bodies in the cytodiagnostic and hystopathological exams, requiring the utilization of technology that is neither routine nor often accessible to confirm the hypothesized diagnosis. Therefore, it is necessary to bring medical professionals up to date about this infectious disease. Read More

Enferm Infecc Microbiol Clin 2008 Jul;26 Suppl 9:42-9

Servicio de Microbiología, Hospital de Cabueñes, Gijón, Asturias, España.

Historically, the diagnosis of sexually transmitted diseases (STDs) has been difficult. The introduction of molecular biology techniques in microbiological diagnosis and their application to non-invasive samples has produced significant advances in the diagnosis of these diseases. Overall, detection of Neisseria gonorrhoeae by molecular biology techniques provides a presumptive diagnosis and requires confirmation by culture in areas with a low prevalence. Read More

South Med J 2009 Jan;102(1):104-5

Division of Infectious Diseases, University of Virginia, Ryan White Clinic, Charlottesville, VA, USA.

A 29-year-old female presented with chronic postpartum abdominal pain. Computerized tomography scan was consistent with ovarian carcinoma, and biopsy yielded macrophages laden with eosinophilic bodies. Cultures, histoplasma serologies, and taxoplasma serologies were negative. Read More

Dermatol Online J 2008 Sep 15;14(9). Epub 2008 Sep 15.

Dermatology, Maulana Azad Medical College, Delhi, India.

Donovanosis is endemic in various parts of the world. Although donovanosis has been reported to co-exist with the human immunodeficiency virus (HIV) infection, to our knowledge there have been no reports of co-existent squamous cell carcinoma (SCC) in an HIV positive patient. In our case the patient did not respond to treatment for donovanosis and on biopsy we realized that the patient had coexistent SCC, which is hitherto unreported with granuloma inguinale. Read More

Indian J Dermatol Venereol Leprol 2008 Sep-Oct;74(5):490-2

Department of STD, Rangaraya Medical College, Government General Hospital, Kakinada, Andhra Pradesh, India.

Donovanosis is a slowly progressive, granulomatous ulcerative disease , caused by Klebsiella (Calymmatobacterium) granulomatis. The disease is known to persist for years together, leading to complications. A male patient aged 30 years with underlying HIV-2 infection presented to the department of STD with painful ulceration over the genital region of 5 months duration, with absence of penis. Read More