Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:2.7.10.2 (focal adhesion kinase)
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Although the availability of antibiotics has reduced the general incidence of donovanosis, the disease remains prevalent in India, Papua New Guinea, parts of southern Africa, and the West Indies. Clinical variants of this sexually transmitted disease include ulcerogranulomatous, hyertrophic, necrotic, and cicatrical. Described here is the case of a 20-year-old Zulu female who developed donovanosis with hypertrophic and ulcerogranulomatous lesions during the third trimester of pregnancy. When the patient presented at 36 weeks, she reported a 10-week history of vaginal ulceration and a 6-week history of swelling in the inguinal region. The ulcerative lesion, located at the introitus, had raised edges 2 cm in diameter, while the dry keloidal-like lesion 2 x 4 cm was present in the inguinal region. This is the first reported case of a combination of two variants of donovanosis in one individual. Histologic examination revealed mildly acanthotic surface squamous epithelium with underlying granulation tissue containing plasma cells, lymphocytes, pockets of neutrophils, and scattered histiocytic cells. Donovan bodies with the typical safety pin appearance were demonstrated by a Giemsa stained tissue smear. Treatment with 500 mg of erythromycin twice daily for 2 weeks resolved the disease. Both the incidence and severity of donovanosis appear to increase during late pregnancy, presumably because of depression of lymphocyte proliferative responses.
Int J STD AIDS
PMID:Donovanosis (granuloma inguinale) in pregnancy. 178 39

Aspects of sexually transmitted diseases (STDS) peculiar to the developing countries in South America and sub-Saharan Africa are discussed. The most common STD infections are N. Gonorrhoeae, Chlamydia trachomatis, T. pallidum and T. vaginalis. Vertical transmission, particularly of syphilis among prostitutes, and of Chlamydia and gonorrhea after ophthalmia neonatorum, are common. Chlamydia is also a common respiratory tract infection in African neonates. Late complications of STDs, infertility and ectopic pregnancy, and particularly pelvic inflammatory disease, are responsible for a high proportion of hospitalizations. Antibiotic resistant gonorrhea strains are common, a result of poorly managed antibiotic treatment. Genital ulcer diseases (GUD), which predispose to HIV infections, are more common in Africa than in developed countries, not only herpes but chancroid, donovanosis and lymphogranuloma venereum. Chancroid, caused by Haemophilus ducreyi, causes 36-49% of ulcers in 2 reports. The L1-L3 strains of Chlamydia trachomatis cause lymphogranuloma venereum, the agent responsible for ulcers in 3.6-6.1% of 2 clinic populations. HIV infections have an equal sex ratio in Africa, with a younger age incidence in women and a high vertical transmission rate, while in Latin America, bisexual men, and increasingly, heterosexual transmission by intravenous drug users is reported. There is also an HIV-2 virus, whose virulence is in question, common in West Africa.
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PMID:The epidemiology of sexually transmitted diseases in Africa and Latin America. 220 6

Travel to tropical countries is an important factor in the spread of sexually transmitted diseases. In spite of intensive anti-AIDS campaigns, some 30% of Swiss tourists have casual sexual contacts abroad. The prevalence of sexually transmitted diseases is higher in tropical countries than in western industrialized countries. More than 25% of cases of gonorrhea treated in Switzerland from 1989-1991 were imported from abroad. The penicillin producing Neisseria gonorrhoeae strains (PPNG) isolated in Switzerland from 1989-1991 are mainly imported from abroad (60%). The typical "imported sexually transmitted diseases" in Switzerland are chancroid, lymphogranuloma venereum and donovanosis. The clinical manifestations, laboratory and special examinations, and treatment of these diseases are described. The most frequent sexually transmitted disease from the so-called "imported tropical STD's" is chancroid. Chancroid is also a major risk factor for HIV infection.
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PMID:[Sexually transmissible diseases following travel in tropical countries]. 832 73

In 1988, in South Africa, staff at the City Health STD Clinic at King Edward VIII Hospital in Durban took tissue smears from 130 men and 41 women to study the epidemiological and clinical features of donovanosis as it relates to a possible risk of HIV-1 transmission. Laboratory personnel used the RapiDiff staining method and histological examinations to detect Donovan bodies in 169 and 2 of the patients, respectively. 96% of patients were 16-39 years old. 55.6% came from rural areas. Lesions were mainly limited to the genital area (96.2% for men and 78% for women). Women were more likely to also have lesions in the inguinal area (17.1% vs. 1.5%). Most donovanosis lesions were ulcero-granulomatous (96.2% for men and 90.2% for women). 3 of the 6 pregnant female patients had hypertrophic lesions. The only case of anal donovanosis was a woman. Even though the patients had ulcers, many continued to have sexual intercourse. 55.4% of the men and 46.3% of the women had ulcers for more than 28 days before coming to the clinic. 40 patients with donovanosis (23%) also had syphilis. Donovanosis was diagnosed in just 1 of 21 regular sexual partners examined. 2 tablets of co-trimoxazole 2 times daily for, mostly, 14 days cured 41 (24%) patients who returned to the clinic for follow-up. Pregnant women took 500 mg of erythromycin 2 times a day. A few cases had to take 100 mg minocycline twice a day. 4 men tested positive for HIV-1 antibodies while none of the women did. 3 of the HIV-1 positive men who returned to the clinic were completely cured of donovanosis. None of these men had HIV-related symptoms. They were treated with co-trimoxazole. These findings suggest that rural health facilities are not adequately serving patients with donovanosis. Since genital ulcer disease, such as donovanosis, facilitates transmission of HIV-1, strategies to curb the spread of HIV should consider specific measures aimed at eradicating donovanosis in areas where it is prevalent.
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PMID:Clinico-epidemiological study of donovanosis in Durban, South Africa. 850 89

Donovanosis has been ignored for many years until recently. The condition still has a limited geographical distribution. A significant epidemic of donovanosis has been identified in KwaZulu/Natal, South Africa where it may be a risk factor for acquiring HIV in men. After a gap of more than 30 years, the organism was cultured by researchers in Durban, South Africa and Darwin, Australia. Polymerase chain reaction (PCR) techniques for donovanosis were developed soon after, most recently using a colorimetric detection system. Similarities between the causative organism, Calymmatobacterium granulomatis and Klebsiella spp. were confirmed. A proposal that the organism be reclassified under the genus Klebsiella has been put forward. Azithromycin has been confirmed as the drug of choice but is yet to be accepted universally because of cost issues. Treatment in patients with significant HIV induced immune deficiency may need to be prolonged. A donovanosis eradication programme is underway amongst the aboriginal community in Australia. Elsewhere, management through current syndromic guidelines for genital ulcers are yet to be validated in areas where donovanosis is endemic. PCR testing should enable further recognition of donovanosis and lead to more concerted efforts in disease control and possible eradication.
Int J STD AIDS 2001 Jul
PMID:Donovanosis: an update. 1271 4

Genital elephantiasis (esthiomene), which is the dramatic end-result of lymphatic obstruction, is rather rare. Although mainly associated with filariasis and sexually transmitted diseases, such as lymphogranuloma venereum and donovanosis, it could also be an uncommon complication of tubercular lymphadenitis, a common infection in tropical countries. We report a rare case of a 32-year-old Indian female in whom genital elephantiasis occurred as a complication of tubercular lymphadenitis.
Int J STD AIDS 2002 Jun
PMID:Genital elephantiasis. 1201 20

The African Union Against Venereal Diseases and Treponematoses (AUVDT), inaugurated in 1979, held its 3rd biannual conference in Nairobi in March 1983 with local participants and participants from 15 English and French speaking countries as well as from Europe, USA and Canada. The conference was devoted to high level training and discussion, workshops on genital ulcer diseases (GUD) and scientific sessions during which many papers were read and discussed. Resolutions and recommendations were made concerning STD in Africa and later passed on to relevant health authorities for necessary action. It was agreed that all African governments who have not already done so should set their own STD control committees as soon as possible. The establishment of microbiological laboratories was strongly urged as well as specific training of health workers. It was felt that gonorrhea and genital ulcer disease were the most frequent sexually transmitted diseases and so management recommendations were made. The efficacy of current regimens using penicillin is increasingly dropping and trimethoprim sulfametrole should be substituted. Failure rates of over 10% would indicate the need to review the accepted regimen. The ideal drug should be effective, orally administered as a single dose, whithout harmful side-effects and preferably not masking syphilis. National programs can purchase drugs through WHO's and UNICEF's purchasing channels at very low prices and governments should utilize these channels. Monitoring of antimicrobial sensitivities should be encouraged and assistance should be sought from university departments of microbiology whenever possible. Genital Ulcer Disease (GUD) is an important public health problem in Africa. Chancroid is the most frequently diagnosed and etiologically proven GUD in eastern, central and southern Africa, accounting for 3-60% of GUD cases. Syphilis, herpetic ulceration, lymphogranuloma venereum and donovanosis are other GUDs found in Africa. Consideration of efficacy, availability, and compliance should be given to treatment. Recent studies have shown that single doses or short-term therapy regimens are as efficient for both ulcers and bubos. Syphilis may be treated with benzathine penicillin im or aqueous procaine penicillin G. No current curative therapy is available for herpes. Local management includes keeping lesions clean and dry; symptomatic treatment involves giving analgesics.
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PMID:AUVDT recommendations for management of gonorrhoea and genital ulcers in Africa. 1234 Jan 86

Genital elephantiasis is an important medical problem in the tropics. It usually affects young and productive age group, and is associated with physical disability and extreme mental anguish. The majority of cases are due to filariasis; however, a small but significant proportion of patients develop genital elephantiasis due to bacterial sexually transmitted infections (STIs), mainly lymphogranuloma venereum (LGV) and donovanosis. STI-related genital elephantiasis should be differentiated from elephantiasis due to other causes, including filariasis, tuberculosis, haematological malignancies, iatrogenic, or dermatological diseases. Laboratory investigations like microscopy of tissue smear and nucleic acid amplification test for donovanosis, and serology and polymerase chain reaction for LGV may help in the diagnosis, but in endemic areas, in the absence of laboratory facilities, diagnosis largely depends on clinical characteristics. The causative agent of LGV, Chlamydia trachomatis serovar L1-L3, is a lymphotropic organism which leads to the development of thrombolymphangitis and perilymphangitis, and lymphadenitis. Long-standing oedema, fibrosis and lymphogranulomatous infiltration result in the final picture of elephantiasis. Elephantiasis in donovanosis is mainly due to constriction of the lymphatics which are trapped in the chronic granulomatous inflammatory response generated by the causative agent, Calymmatobacterium (Klebsiella) granulomatis. The LGV-associated genital elephantiasis should be treated with a prolonged course of doxycycline given orally, while donovanosis should be treated with azithromycin or trimethoprim-sulphamethoxazole combination given for a minimum of three weeks. Genital elephantiasis is not completely reversible with medical therapy alone and often needs to be reduced surgically.
Int J STD AIDS 2006 Mar
PMID:Genital elephantiasis and sexually transmitted infections - revisited. 1651

We report on a patient from a London clinic, (a Jamaican heterosexual man known to have herpes) who has donovanosis and syphilis in a single genital ulcer. The case highlights the importance of careful clinical examination of genital ulcers.
Int J STD AIDS 2007 Jan
PMID:A hat trick of ulcerating pathogens in a single genital lesion. 1732 68

A clinical and investigational study of 25 cases of Donovanosis was undertaken. The incidence was found to be 1.53% of all STD cases and 2.9% of GUD. M:F ratio was 2.12:1. Incidence was more in unmarried people. Fleshy exuberant type was seen in 88% of cases. Two patients (8%) had extragenital ulcers. Donovan bodies were found in 88%. Pseudo elephantiasis was seen in 8 patients. Biopsy was done in 8 cases and showed acanthosis, plasma cell infiltration and pseudo epitheliomatous hyperplasia. One patient developed squamous cell carcinoma of vulva.
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PMID:A clinical and investigational study of donovanosis. 1764 66


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