Granuloma

Granuloma inguinale is also known as:
* Donovanosis
* Granuloma venereum

Granuloma inguinale is a sexually transmitted disease (STD) occurring more frequently in males.  It is caused by a bacteria usually found in the tropics and subtropical areas and is chronic and mildly contagious.

Very few cases are reported in the United States, the main target group being homosexual men aged between 20-45.

Symptoms

One week to several months (average incubation 8-80 days) after the initial exposure to the infection lumps or blisters appear in the genital area, slowly enlarging into open sores, similar to those caused by chancroid, syphilis or herpes.

These mainly appear on:
* the mucous membranes around the genital area;
* the skin;

The sores spread along  warm, moist folds of skin from the groin to the genitals and anus.

Although discomfort increases as the infection progresses the sores are  not necessarily painful

In men
Lesions first appear:
* on the head of the penis;
* on the shaft of the penis;

In women
Lesions first appear:
* at the entrance to the vagina;
* at the inner labia;
 

If untreated the sores grow larger and spread throughout the groin, which can cause:
* abscesses;
* cancer (in rare cases);
* intestinal and rectal symptoms;
* secondary infections;

Other symptoms
* Swelling of the lymph nodes;

Inguinal nodes spread infection into overlaying tissues which can cause:
* abscess formation (pseudobubo);
* ulceration of the overlaying skin;

Untreated infections can:
* persist and slowly spread;
* resolve spontaneously;

Transmission

Granuloma inguinale can be transmitted:
* If infected persons remain untreated and bacteria from lesions are present;
* Through anal sex or oral-anal contact;
* Through contaminated food or water;
* Through sexual contact with an infected individual;
* Through touching or scratching other parts of the body
* When the disease is in its early stages and symptoms go unnoticed

Re-infection and spreading of the infection can occur through:
* open wounds;
* skin abrasions;

Diagnosis

* Blood tests (to determine it is not another STD with similar symptoms);
* Microscopic examination of cells from the edge of the sores;
* Tissue sample collected by biopsy;
* Visual observation of external symptoms;

Examination

* Cellular material is collected and placed onto a glass slide ;
* Biopsy
Bopsies are best stained with silver stains, such as Warthin-Stary or Giemsa, Wright's  or  Leishman stain;
* Blood Tests
Successful culture of the causative organism, Klebsiella granulomatis has been reported in human peripheral blood monocytes and in HEp-2 cells;
* Polymerase chain reaction (PCR) methods and serological tests are not yet routinely available

Treatment

To eliminate the infection a two-week course of antibiotics is usually administered using:
* Azithromycin, which has been used successfully with Australian aborigines;
* Ciprofloxacin, which has better bioavailability than Norfloxacin;
* Doxycicline is recommended based on trials carried out with older Tetracyclines;
* Erythromycin;
* Gentamicin is recommended to patients whose lesions do not respond to other medication in the first few days;
* Minocycline;
* Sulfamethoxazole;
* Tetracycline;

Sores:
* begin to clear within a week after treatment begins;
* will often heal completely within 3-5 weeks;

A minimum of 3 weeks' treatment is recommended

Note
The addition of proteolytic emzymes can improve the effectiveness of antibiotics

Treatment during Pregnancy or Lactation
* Erythromycin has been used successfully in pregnant women

Note
The following antibiotics are not recommended during pregnancy or lactation:
* Co-trimoxazole;
* Doxycycyline;
* Gentamicin;
* Norfloxacin;

Children born to mothers with untreated genital lesions are at risk of infection and a course of prophylactic antibiotics is recommended.

Naturopathic Treatment
* Abstain from sexual activity while healing from this bacterial infection;
* Direct, local, anti-microbial applications;
* Fortify the immune system to fight the infection and heal the body;

Dietary Recommendations
Include:
* fresh fruits;
* leafy green vegetables;
* pure water;
* whole grains

Avoid:
* alcohol;
* carbonated beverages;
* fast foods;
* fruit juice;
* processed foods;
* refined white flour, including pasta, bread, desserts;
* sugar;

Nutritional Supplements
Proteolytic enzymes:
* Bromelain 400mg;
* Wobenzyme N five tablets 3-4 times a day not with meals, and;
* Vitamin A;
* Vitamin C 1,000 mg 3 times a day with meals;
* Zinc 30 mg daily;

Herbal Treatment
* Goldenseal (Hydrastis Canadensis), strong infusion or poultice applied locally to sores;
* Goldenseal (Hydrastis Canadensis)/Vitamin A suppository;

Other Treatment
* Warm sitz baths with several drops Tea Tree oil (Melaleuca alternifolia);
Vaginal douching using the following dried herbs, which have potent anti-microbial properties.
* Goldenseal (Hydrastis canadensis);
* Oregon Grape Root (Mahonia aqjuifolium);

Prevention

* Avoid oral/anal and unprotected penile/anal sex if sexually active;
* Carefully wash the genitals after sex;
* If you suspect you have come in contact with an infected person contact your local STD Clinic, health professional or urologist immediately;
* Latex condoms put on before sex and worn until the penis is withdrawn;
* Limit sexual relationships to a single, uninfected partner;
* Notify all sexual contacts immediately so they can obtain treatment if infected;
* To avoid re-infection patients should be monitored until all symptoms have ceased;

Note
* Douching or urinating after sex does not prevent STIs;

Prognosis

If untreated the sores grow larger and spread throughout the groin and can cause:
* abscesses;
* cancer (in rare cases);
* intestinal and rectal symptoms;
* secondary infections;

Complications
* Can be spread to other parts of the body
* Development of squamous carcinoma
* Extensive destruction and mutilation of the genital
* organs
* Genital lymphoedema
* Hematogenous (related to the blood) dissemination to bone and viscera, particularly during pregnancy
* Hemorrhage
* Lesions of the ears of infants
* Primary lesions of the mouth and cervix which are often mistaken for malignant lesions;
* Psoas (muscle in the loins) and perinephric (around the kidneys) abscesses;
* Scars (cicatrisation) left by the sores may be precancerous therefore annual medical checkups should be undertaken;
* Spinal cord compression
* Past infection does not make a person immune and there is no evidence of natural resistance;