Donovanosis natural history, complications and prognosis

The incubation period of Klebsiella granulomatis is debated and ranges from 1 to 360 days with a median time of 50 days. Donovanosis starts as a papule or subcutaneous nodule which eventually ulcerates. The ulcer progresses to create areas of granulomatous tissue. Pseudoepitheliomatous hyperplasia of lesion borders often occurs. Ulcers autoinoculate creating multiple lesions. “Pseudobuboes” may also develop. Chronic ulcers leads to fibrosis and eventually Elephantiasis-like swelling. K. granulomatis may disseminate causing extragenital lesions and systemic infection. Complications include: genital damage and scarring, elephantiasis, phimosis in men, [strictures]] or fistulas of the urethra, vagina, or anus, foinfection with other sexually transmitted infections and carcinoma (in 0.25% of cases). Prognosis is poor without treatment because the disease has a high morbidity; untreated disease leads to damage of the genital tissue, scarring, and elephantiasis. Donovanosis may reoccur after 6 to 18 months after treatment.

• The incubation period of Klebsiella granulomatis is debated and ranges from 1 to 360 days with a median time of 50 days.^[1]
• Donovanosis begins with a firm papule or subcutaneous nodule which eventually ulcerates.^[2]
• The ulcer slowly progresses centrifugally, without pain, to form areas of granulomatous tissue.^[3]
• Pseudoepitheliomatous hyperplasia of lesion borders, resembling squamous cell carcinoma, often occurs.
• Ulcers may autoinoculate creating multiple lesions.
• “Pseudobuboes” may develop, which are nodular lesions that resemble lymphadenitis.^[4]
• Fibrosis may occur leading to elephantiasis-like swelling as a result of chronic ulcers.
• K. granulomatis may disseminate causing extragenital lesions in the following areas:^[4]

• mouth
• cheek
• neck
• pharynx
• larynx
• nose
• thorax

• K. granulomatis may also disseminate to the abdomen, intestines, liver, lungs, uterus, and ovaries causing systemic infection.^[3]

• Genital damage and scarring
• Elephantiasis-like swelling^[4]
• Phimosis in men
• Strictures or fistulas of the urethra, vagina, or anus^[3]
• Coinfection with other sexually transmitted infections including: syphillis, chancroid, and Human Immunodeficiency Virus (HIV)
• Carcinoma (in 0.25% of cases)^[2]

• Treating this disease early decreases the chances of tissue damage or scarring. Untreated disease leads to damage of the genital tissue.
• Donovanosis may reoccur after 6 to 18 months even after successful treatment.^[3]

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