RESUMO

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.

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RESUMO

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.

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RESUMO

En el Centro de Referencia de Enfermedades de Transmisión Sexual A. Barton, Callao, Perú, entre Enero de 1996 y Junio de 1997, se reportaron 11 casos de Ulcera Genital Crónica (UGC), los cuales por criterios clínico, epidemiológico y de respuesta terapéutica tuvieron el diagnóstico probable de Donovanosis. Seis de los pacientes eran hombres que tenían sexo con hombres y la localización más frecuente fue en el ano. En diez pacientes hubo una respuesta al tratamiento con Doxicilina y Trimetoprin/Sulfametoxazol. Diez pacientes aceptaron realizarse la prueba de ELISA para VIH, resultando seis de ellos positivos con Western Blot confirmatorio. La alta pevalencia de infección por VIH en este grupo nos permite asumir que la UGC es un importante facilitador de la infección por VIH.

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Two cross-sectional surveys were undertaken, from December 1982 to August 1983 and from November 1990 to January 1991, to estimate the prevalence rates of genital ulcer disease (GUD) in all patients presenting with a new sexually transmitted disease (STD) complaint to the STD clinic at the Comprehensive Health Centre in Kingston, Jamaica. Diagnosis of syphilis and human immunodeficiency virus (HIV) infection was based on results of laboratory tests, but diagnosis of the other STDs was based on clinical features. Data from these two surveys were compared, and reported national annual incidence data for GUD reviewed. In 1982/83 6.8% of 23,050 patients had GUD, men (9.3%) more often than women (4.2%; p < 0.001). In 1990/91 the prevalence rate was 12.8%, with increased rates for both men (18.2%) and women (6.8%; p < 0.001). In patients with GUD, a clinical diagnosis of genital herpes was made, in 1982/83 and 1990/91, respectively, in 16.8% and 7.8% of the patients; syphilis, in 12.9% and 18.8%; chancroid, in 12.4% and 13.3%; viral warts, in 5.7% and 6.3%; lymphogranuloma venereum, in 4.1% and 3.9%; and granuloma inguinale, in 3.6% and 2.3%. In men the rate for syphilis was 19% in 1990/91 and 8% in 1982/83 (p = 0.001); and for genital herpes it was 7% in 1990/91 and 17% in 1982/83 (p = 0.025). These reversals were attributed to intense media coverage of herpes in 1982/83. There was no difference in prevalence rates between the two surveys for these diseases in women, or for lymphogranuloma venereum, granuloma inguinale and genital warts in men and women. A clinical diagnosis could not be made in 44.4% of cases in 1982/83 (particularly in men), and in 47.6% of cases in 1990/91. GUDs facilitate transmission and adversely affect the prognosis of HIV. The increase in their prevalence has implications for the evolution of the local HIV epidemic, and should be addressed effectively by strengthening the STD/HIV control programme.

PIP: The prevalence of genital ulcer disease (GUD) was investigated in two cross-sectional studies of patients presenting to the sexually transmitted disease (STD) clinic at the Comprehensive Health Center in Kingston, Jamaica, between December 1982 and August 1983 (n = 23,050) and between November 1990 and January 1991 (n = 1001). The median age of participants was 26 years for men and 25 years for women; most were low-income inner-city residents. The prevalence of GUD rose from 6.8% (9.3% in men and 4.2% in women) in the 1982-83 survey to 12.8% (18.2% in men and 6.8% in women) in 1990-91. In 1982-83 and 1990-91, respectively, genital herpes was diagnosed in 16.8% and 7.8% of patients, syphilis in 12.9% and 18.8%, chancroid in 12.4% and 13.3%, viral warts in 5.7% and 6.3%, lymphogranuloma venereum in 4.1% and 3.9%, and granuloma inguinale in 3.6% and 2.3%. A clinical diagnosis could not be made in 44.4% of cases in 1982-83 and in 47.6% in 1990-91. Since GUDs facilitate the transmission of HIV, HIV prevention efforts must include the strengthening of STD control programs. All cases of GUD should be screened for both syphilis and HIV, with prompt treatment to reduce the period of GUD transmissibility. Jamaica has revised its national STD case management guidelines to include simplified algorithms for GUD management and strengthened STD surveillance and contact tracing. Changes in GUD prevalence over time may be a useful indicator for evaluating the impact of STD/HIV interventions.

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Foram estudados 259 casos de donovanose registrados no Serviç de Deramtologia do Departamento de Medicina Tropical/UFPA entre 1954-1990. Observa-se que no período 1954-2974 existiam nos arquivos apenas 56 prontuários da doença, enquanto que no último quinquênio estudado (1086-1990) foram identificados 133 casos. Para os autores esse crescimento esta ligado a excessiva liberalidade sexual, ao homossexualismo e as precárias condiçöes sócio-econômicas, acentuada nos últimos tempos

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From 1954 to 1990 granuloma inguinale was diagnosed in 259 patients al the dermatology service of the Universidade Federal do Pará in Belém, Brazil. Among them, 56 cases had occurred in the twenty-year period 1954-1974 and as many as 133 cases were seen during the last five years only. Greater sexual liberty, poor social and economic conditions, and especially increasing homosexual behavior were implicated by the authors as chief determinants for this augmented incidence of the disease.

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24 cases of Donovanosis (Granuloma inguinale) have been observed at the Dermatology Clinic of the Centre Hospitalier of Cayenne (French Guyana) between 1970 and 1980, representing a high rate for a 60,000 population. All the patients were coloured people. The disease is more important in the cutaneous parts of the ano-genital areas, than on the mucous parts. The "carcinoid" aspects of some histopathological exams must be considered with the bacteriological research and the very soft clinical aspects. It is often caused by intrarectal sexual contacts whether homo- or heterosexual. The high rate of Donovanosis within the homosexual population is a good argument for an intestinal localisation of the germ Calymnatobacterium granulomatis. All the cases diagnosed show an individual susceptibility to this disease. A deficit of cellular immunity as found in lepromatous leprosy seems a very attractive hypothesis. The treatment with 4 g of streptomycin by day during 5 days or more is considered as the best actually.

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