Donovanosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]; Nate Michalak, B.A.
Overview
Antimicrobial therapy is the mainstay of treatment for donovanosis. Azithromycin 1 g PO once per week for at least 3 weeks and until all lesions have completely healed is the preferred regimen. Alternative regimens include doxycycline, ciprofloxacin, erythromycin, and trimethoprim-sulfamethoxazole. Pregnant women should be treated with erythromycin. Sexual partners should also be evaluated and treated.
Medical Therapy
- A limited number of studies on donovanosis treatment have been published.
- Treatment halts progression of lesions, although prolonged therapy is usually required to permit granulation and reepithelialization of the ulcers.
- Healing typically proceeds inward from the ulcer margins.
- Relapse can occur 6–18 months after apparently effective therapy.
- Several antimicrobial regimens have been effective, but a limited number of controlled trials have been published.[1]
Antimicrobial Therapy
- Preferred regimen: Azithromycin 1 g PO once per week for at least 3 weeks and until all lesions have completely healed[2]
- Alternative regimen (1): Doxycycline 100 mg PO bid for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (2): Ciprofloxacin 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (3): Erythromycin base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
- Alternative regimen (4): Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed
- Note: The addition of an Aminoglycoside (e.g., Gentamicin 1 mg/kg IV q8h) to these regimens can be considered if improvement is not evident within the first few days of therapy.
Special Considerations
- Pregnancy: Doxycycline, ciprofloxacin and sulfonamides are contraindicated among pregnant women. Pregnant and lactating women should be treated with the erythromycin or azithromycin regimen, and consideration should be given to the addition of a parenteral aminoglycoside (e.g., gentamicin).
- HIV coinfection: Individuals with both donovanosis and HIV infection should receive the same regimens as those who are HIV-negative; however, the addition of a parenteral aminoglycoside (e.g., gentamicin) can also be considered.[2]
Follow-Up
Patients should be followed clinically until signs and symptoms resolve.[2]
Treatment of Sex Partners
Persons who have had sexual contact with a patient who has granuloma inguinale within the 60 days before onset of the patient’s symptoms should be examined and offered therapy.
- Note: the value of empiric therapy in the absence of clinical signs and symptoms has not been established.[2]
Surgical Care
Surgery may be necessary to correct elephantiasis, strictures, or fistulae.
References
- ↑ O'Farrell N (2002). "Donovanosis". Sex Transm Infect. 78 (6): 452–7. PMC 1758360. PMID 12473810.
- ↑ 2.0 2.1 2.2 2.3 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention (June 4, 2015). http://www.cdc.gov/std/tg2015/donovanosis.htm Accessed March 03 2016