A clinico-epidemiological study of donovanosis

Researchers conducted a retrospective study of confirmed cases of donovanosis, a sexually transmitted disease (STD), between January 1980- December 1987 at the STD clinic at the Jawaharlal Institute of Postgraduate Medical Education and Research in Pondicherry, India to determine if a change in the disease's trend occurred. 6.6% of all STD cases at the clinic had donovanosis, especially among 20-30 year olds. This compared to 5.4% in 1968-1969. Incidence did fall, however, to 3.6% in 1987. Incidence among males gradually increased from 1980-1982 then gradually fell. This decline was proportional to the total number of STD patients. All but 1 female reported not having sex outside of marriage. A low of 25% of both husbands and wives of married pairs had donovanosis. The most frequent clinical type of donovanosis was fleshy exuberant then either necrotic or sclerotic types. It affected mainly the genitalia, Syphilis was the most likely associated STD in both sexes. Even though there was a gradual decline in donovanosis, it still made up a major share of all STDs despite the availability of effective treatment (co-trimoxazole, chloromycetin, doxycycline, and tetracycline). In this same time period, a 7.2% and 1.7% increase in other STDs among female and male teenagers respectively occurred, yet, except for 1 case, there were no cases of donovanosis among teenagers. A possible explanation for the inability of this clinic to control donovanosis could be poor contact tracing.     

Pattern of sexually transmitted diseases at Patiala

The distribution of sexually transmitted diseases (STDs) in 500 patients coming to the Department of Skin and VD, Government Medical College, Patiala, India, from 1983-1988 is listed. The patients were 70% male, aged 15-58, mostly aged 21-30, and 85% were of low income or unemployed. 17.2% were teens. The diagnoses from most to least frequent were: syphilis 29.6%, vaginitis 15%, condylomata accuminata 12%, genital herpes 11.6%, gonorrhea 10%, chancroid 8.8%, balanoposthitis 5.4%, non-gonococcal urethritis 5.2%, and lymphogranuloma venereum, Moluscum contagiosum and donovanosis each 0.2%. 12% were mixed infections. Most men cited prostitutes as the source of their illness, while women reported spouses.     

Rising incidence of genital herpes over two decades in a sexually transmitted disease clinic in north India

Genital herpes, which was considered to be a minor sexually transmitted disease (STD) in the past in developing countries, is rapidly increasing; in contrast, bacterial STDs are declining. This changing trend of various STDs prompted us to analyze our data retrospectively to see whether a similar change is occurring in this part of India as well. The records of sexually transmitted diseases (STDs) clinic attendees from January 1977 to December 2000 were analyzed. The demographic profile of patients with genital herpes was also considered for analysis. STDs were diagnosed clinically and by appropriate laboratory tests wherever applicable. VDRL test was done in all patients, and HIV antibody detection was performed from 1987 onwards. The incidences of chancroid, donovanosis, and gonorrhea were 12.2%, 6.3%, and 16.9%, respectively, from January 1977 to December 1985. The figures for the same decreased to 2.5%, 0.9%, and 2.3%, respectively, from January 1993 to December 2000. The decreasing incidence of the above bacterial STDs is statistically significant (p<0.001). However, there was an approximately two-fold increase in the incidence of genital herpes in recent years (20.5%) in comparison to the figures from the late 70s (11.4%). Molluscum contagiosum also showed an upward trend (1% in 1977-85 vs. 9.8% in 1993-2000). Condylomata accuminata remained almost unchanged (21.4% in 1977-85 vs. 20% in 1993-2000). To conclude, a significant increase in the number of viral STDs and a decline in the bacterial diseases were observed in recent years in comparison to the figures from the late 70s. This may be due to awareness of HIV, success of control programs, syndromic management of STDs, and adoption of safer sexual practices, which prevent bacterial STDs more efficiently than viral ones.     

Changing trends in sexually transmitted diseases in North Eastern India

A retrospective data analysis was carried out to find the trends in frequency and distribution of different STDs in North Eastern (NE) India during 1995-1999. The commonest STD was chancroid (25.7%) followed by condylomata acuminata (CA), nongonococcal urethritis (NGU), lymphogranuloma venereum (LGV), syphilis, gonorrhoea (GONO), herpes genitalis (HG), mixed infection (MI) and balanoposthitis (BP). Interestingly no case of donovanosis (Dono) was seen. HIV infection accounted for 9.62% of the total STD patients. A comparison of the present data with that reported a decade back (1986-1990) revealed a sharp decline in the incidence of syphilis, chancroid, GONO, whereas a conspicuous upward trend in CA and NGU. Factors responsible for these variations are analysed briefly.     

HLA antigens in donovanosis (granuloma inguinale).

OBJECTIVE--To compare the frequencies of HLA antigens in patients with donovanosis and in controls. DESIGN--HLA Class I, Class II and DQ antigens were detected in patients with genital ulceration caused by donovanosis and in a control group. SETTING--City Health STD Clinic, King Edward VIII Hospital, Durban, South Africa. Participants--Sixty (47 men, 13 women) patients with donovanosis. RESULTS--HLA B57 was detected in nine of 60 (15%) with donovanosis and 75 of 1478 (5.1%) controls (RR = 3.3 chi 2 = 11.0, p = 0.001, p corrected = 0.026). CONCLUSIONS--A possible link between donovanosis and HLA B57 could be explained by coexisting alleles or immune response genes in linkage disequilibrium altering disease susceptibility.     

Clinico-epidemiological study of donovanosis in Durban, South Africa.

OBJECTIVE: To describe the epidemiological and clinical features of donovanosis and their relevance to the possible coincident risk of HIV-1 transmission in patients attending an STD clinic. DESIGN: Assessment of patients with donovanosis diagnosed by the detection of Donovan bodies on tissue smears stained by the RapiDiff technique. SETTING: City Health STD Clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS: One hundred and seventy one patients with donovanosis. RESULTS: Donovan bodies were detected in 171 (130 men, 41 women). Ulcers were present for longer than 28 days in 72 (55.4%) men and 19 (46.3%) women. Ninety five (55.6%) came from rural areas. Lesions were ulcero-granulomatous in 162, hypertrophic in eight and necrotic in one. Anal lesions were detected in one woman. Only one of 21 regular sexual partners examined was infected with donovanosis. Complete healing was observed in 41 (24%) who attended for follow up. Extensive lesions were sometimes observed in pregnant women. Serological tests for syphilis were positive in 40 (23.4%). HIV-1 antibodies were detected in 4/48 men and 0/15 women who underwent HIV testing. Donovanosis ulcers in three HIV-1 seropositive men were cured by standard antibiotic therapy. CONCLUSIONS: Delay in presentation, extensive areas of genital ulceration and lack of co-existent infection with donovanosis among sexual partners were notable features. Primary health care facilities in rural areas do not appear to be providing an adequate service for patients with donovanosis. HIV control programmes should consider specific measures aimed at eradicating donovanosis in areas where the condition is prevalent.     

Sexually transmitted diseases during pregnancy: a synthesis of particularities

Sexually transmitted diseases (STDs) have a significant prevalence in both the general population and pregnant women. Accordingly, we consider the physiological changes of the maternal organism that can alter the clinical course of these diseases. In addition, obstetric and neonatal complications may occur, resulting in increased maternal and infant morbidity and mortality. We explore features of the natural course and treatment during pregnancy of the major STDs: soft chancre, donovanosis, gonorrhea, chlamydia, viral hepatitis, genital herpes, human papillomavirus (HPV) infection, lymphogranuloma venereum, syphilis, and vulvovaginitis. We believe that health professionals should pay careful attention to STDs, particularly in relation to early diagnosis and precautions on the use of drugs during pregnancy. Prevention and partner treatment to achieve effective results are also extremely relevant.     

A forgotten disease reminds itself with a rare complication

Diagnosed cases of sexually transmitted diseases (STD) represent tip of the iceberg and Donovanosis in one of them. Donovanosis, in most cases is obvious clinically, but rely for its confirmation on the demonstration of donovan bodies in histological sections and cytological preparation. In an extremely rare setting, this disease may get complicated by the development of squamous cell carcinoma. We report this occurrence in an 18-year-old girl to review the currently forgotten status of donovanosis amongst the STDs and the poor outcome of the disease if left untreated.     

The prevalence of symptomatic sexually transmitted diseases and human immunodeficiency virus infection in outpatients in Lilongwe, Malawi.

In June 1989 a pilot study on the prevalence of STDs was performed at Kamuzu Central Hospital, Lilogwe, Malawi. Among unselected out-patients an STD prevalence of 4.4% was found. The patients were predominantly males (82.7%), the age was predominantly 20-35 yr. The distribution of the diagnoses was dominated by a relatively large proportion of "ulcer-diseases" (syphilis, chancroid and lymphogranuloma venereum) making up 67% of the patients. Almost two thirds of the patients were HIV-positive (62.4%). No significant difference was found in HIV-infection prevalence when patients with ulcer diseases were compared with patients with discharges. Among the patients with gonorrhoea a prevalence of penicillinase-producing Neisseria gonorrhoeae of 53% was found. It is concluded that a plan for the management of STDs is urgently needed as it is of paramount importance to combat STDs in order to prevent the spread of HIV-infection.     

Antibiotic use in sexually transmissible diseases

Sexually transmissible diseases (STDs) remain a major health issue worldwide, with approximately 300 million new cases annually. STDs caused by bacteria can be treated with antibiotics, although the susceptibility pattern of many etiologic microbes has changed over the past few decades. Syphilis remains best managed with single-dose benzathine penicillin G. Other single-dose antibiotic regimens for lues are either associated with clinical failure or of uncertain dosage. However, single-dose azithromycin and ceftriaxone are suitable for chancroid. Lymphogranuloma venereum, reemergent as a cause of proctitis, is treated with prolonged courses of doxycycline or minocycline. Trimethoprim-sulfamethoxazole has replaced tetracycline derivatives as preferred treatment for donovanosis in many regions. Parenteral cephalosporins, such as ceftriaxone, cefotaxime, and ceftizoxime, are initial interventions for disseminated gonococcemia. Pending culture results, genital bite wounds (often consisting of deep, painful ulcerations) should be treated with high-dose amoxicillin-clavulanic acid.     

Std trends in chengalpattu hospital

A retrospective data analysis was carried out to find the trends in frequency and distribution of different STDs at Chengalpattu during 1988-1994. Of the 4549 patients who attended the clinic 3621 (79.6%) were males and 928 (20.4%) were females. The commonest STD was Chancroid (24.4%) in men and Syphillis (29%) in women. Balanoposthitis (11.4%) ranked third among STDs in males. Though the STD attendance showed a declining trend, most diseases showed a constant distribution. The percentage composition of secondary and latent syphillis, Genital Warts, Genital Herpes and the Non-Venereal group showed an increased composition in recent years. Primary syphillis in females showed a definite declining trend. The HIV sero-positive detection rate was 2.06%. Of the 1116 patients screened for HIV antibody, 23 patients were detected sero-positive. Time Series Regression Analysis was used to predict the number of patients who would attend the STD clinic with various STDs in 1995 and 1996 to help in the understanding of the disease load and pattern in future, in resources management and in developing and evaluating preventive measures.     

Ceftriaxone in the treatment of chronic donovanosis in central Australia.

OBJECTIVES--To determine the effectiveness of intramuscular (IM) ceftriaxone sodium in the treatment of chronic donovanosis, and the acceptability to patients and staff of supervised outpatient treatment in rural clinics. METHODS--We collected demographic and sexual health data from participants using a standard questionnaire, and recorded their donovanosis lesions at baseline using genital diagrams. Treatment consisted of a single daily IM injection of 1 g ceftriaxone diluted in 2 ml of 1% lignocaine. Clinic staff followed patients for between three and 12 months, enabling the detection of late recurrences. SETTING--Rural Aboriginal communities in central Australia. PARTICIPANTS--The study describes eight women and four men with chronic donovanosis in detail, and summarises the outcome in 12 additional cases. All cases presented with advanced lesions which had failed to heal on the standard oral antibiotic regimens used in the region. RESULTS--The mean duration of infection was 3.0 years (SD 1.9 years), and between four and ten courses of antibiotics had been prescribed for six of the 12 patients. Patients received between 7-26g of ceftriaxone sodium. Clinical improvement was dramatic in most lesions, and four patients healed completely without recurrence after a total 7-10g of ceftriaxone. Mild recurrences responded to further ceftriaxone or short courses of oral antibiotics. Treatment was well tolerated, and both patient and staff compliance high. CONCLUSION--Donovanosis is an important cause of chronic genital ulceration in central Australia, and is potentially an important risk factor for HIV transmission in Aboriginal communities. The pharmacokinetics and safety profile of ceftriaxone make it a useful and cost-effective agent in the ambulatory management of donovanosis, especially in remote communities. Supervised multidrug regimens of two or more long-acting agents may provide the best answer in donovanosis, administered through the existing health care infrastructure.     

Pilot study of azithromycin in the treatment of genital donovanosis.

OBJECTIVES: To determine the effectiveness of azithromycin, an azalide antibiotic with long tissue half-life, in a pilot study of patients with genital donovanosis in the Northern Territory, Australia. DESIGN: Patients with histologically confirmed donovanosis were randomised to receive one of two open-label azithromycin dosage regimens: Regimen A--1.0 g once weekly for 4 weeks; or Regimen B--500 mg daily for 7 days. Patients were assessed at 6 weeks and classified as either "cured", "improved" or "failed". RESULTS: Seven patients received regimen A and 4 received regimen B. Six weeks after commencing treatment the genital ulcers of four patients receiving regimen A and one patient receiving regimen B had healed; the lesions of the other six patients (3 in each regimen) were "improved". No patient failed to respond and no significant adverse reaction was recognised. The eleven patients were reviewed after completing the six-week trial; all lesions had re-epithelialised without further antibiotic treatment, no relapses had occurred, the longest follow-up period being seven months. A further 17 patients with donovanosis who were unable to meet the entry criteria were also treated successfully with azithromycin during the study period. CONCLUSIONS: This is the first time that azithromycin has been shown to have clinical activity against donovanosis. Poor compliance with prolonged courses of antibiotics is one of the major barriers to control of the disease. Intermittent or short-course therapy, made possible by the long tissue half-life of the drug, could facilitate control of donovanosis in endemic populations if the high cost of medication can be addressed.     

Short treatment of donovanosis with azithromycin

INTRODUCTION: Azithromycine is recommended in the treatment of donovanosis with a 7-day treatment cycle. We report the efficacy of a single cure of 1 gram in two patients.OBSERVATIONS: Four patients, presenting with donovanosis, were treated with azithromycine according to 2 regimens. The first used 500 mg/d the molecule during 1 week, the second used azithromycine in single cure of 1 gram. The latter led to the complete cure of 2 patients. DISCUSSION: Many antibiotics are used in the treatment of donovanosis. Since 1996, Australian authors have used azithromycine in this indication. A single dose of this molecule appears effective in recent and confined donovanosis.     

Trends in reported cases of donovanosis in Durban, South Africa.

OBJECTIVE--To investigate recent trends in reported cases of donovanosis (granuloma inguinale) in Durban, South Africa. DESIGN--The annual reports of the Medical Officer of Health for Durban 1958-1988 were reviewed to identify cases of donovanosis, genital ulcer disease (GUD) and new patients with sexually transmitted diseases (STD). A rapid staining technique for the detection of Donovan bodies was introduced in 1988. SETTING--City Health STD Clinic, King Edward VIII Hospital, Durban. RESULTS--An initial peak was identified in men 1969-1974. A second peak was recorded in 1988 when reported cases of donovanosis (313) were the highest since records commenced. Both peaks were unrelated to either increases in the numbers of new attenders with STD or patients with GUD. CONCLUSION--The recent increase in donovanosis in Durban may reflect either a new epidemic or under-reporting of a disease previously diagnosed on clinical grounds. Improved control of donovanosis, a condition sometimes causing extensive GUD, and which has been implicated in HIV-1 transmission in local men, should be targeted in HIV control programmes.     

STD trends in regional institute of medical sciences, Manipur

A study carried out among the 2230 STD patients during 1996-2000 shows the types, distribution and trends of the various STDs seen in our hospital. STDs contribute 3.30% of the total skin OPD cases. Males dominate with 89.3% of STD cases. Bolanoposthitis (22%) was the commonest STD, followed by gonorrhoea (11.8%) and nongonococcal urethritis (NGU) being 11.2%. Syphilis was seen in 6.2% of the cases. The prevalence of VDRL reactivity and HIV reactivity remains almost the some being 8.49% and 8.21% respectively. There is increased occurrence of various psychosexual disorders among the affected patients.     

Pattern of sexually transmitted diseases in Allahabad

The distribution of sexually transmitted diseases (STDs) in 1922 consecutive patients of the PG Department of Medicine, MLN Medical College, Allahabad, India, from 1978-1988 is reviewed. 95.3% were male; ages ranged from 4 months-72 years; most were aged 20-29 years old. The STDs found in descending order were chancroid in 33.1%, gonorrhea 21.3%, syphilis 16.7%, genital herpes 13.9%, venereal warts 5.41%, balanoposthitis 3.6%, Donovanosis 3.02%, condyloma accuminata 2.5%, lymphogranuloma venereum 1.46%, and molluscum contagiosum 0.62%. 1.14% were mixed infections. In women secondary syphilis was the most common infection. Men almost always reported prostitutes as the source of their illness, while women always cited spouses: 86% of husbands of infected married women had evidence of STDs.     

A retrospective study of the pattern of sexually transmitted diseases during a ten-year period

BACKGROUND: Proper knowledge of the patterns of sexually transmitted diseases (STDs) in different geographical regions is necessary for evolving proper strategies for control of these diseases. AIMS: To study the pattern of STDs and to analyze the changes during a ten-year period from 1990 among patients attending Medical College Hospital, Kottayam. METHODS: Case records of 686 patients with STDs who attended the outpatient wing of the Department of Dermatology and Venereology were studied. RESULTS: There were 504 males and 182 females in the total of 686 patients. Marital contact alone was reported by 123 (67.6%) female patients. Genital ulcer diseases (GUDs) accounted for the maximum number of STDs, with 504 cases (73.5%), followed by condyloma acuminatum (17.5%) and gonorrhea (10.1%). Forty-three patients had multiple infections. The total number of patients during the first year of study was 129, while it was 41 during the last year. Bacterial STDs showed a striking reduction in numbers. The decline was less marked in the case of viral STDs. CONCLUSION: The majority of patients had genital ulcer diseases. Spouses were the most common source of infection for female patients. There was a marked decline in the number of patients with various STDs during the ten-year period. The decline was more evident in the bacterial STDs resulting in an apparent increase of the viral STDs towards the end of the period of study.     

Extragenital donovanosis in a patient with AIDS

A case of extragenital donovanosis in a patient with AIDS is reported from Zimbabwe. Despite the rarity of donovanosis in Zimbabwe it is important that health workers are familiar with this disease since donovanosis increases the risk of HIV transmission and appropriate treatment is often successful even in patients with severe immunodeficiency.




     

STD患者阴道加德纳菌及其他病原菌感染状况

目的了解STD患者阴道加德纳菌及其他病原菌感染状况。方法收集2003年10月～2004年6月无锡地区682例STD患者的生殖道拭子标本进行阴道加德纳菌(GV)、解脲脲原体(UU)、人型支原体(MH)、生殖支原体(MG)、肺炎支原体(MP)、淋病奈瑟菌(NG)、沙眼衣原体(CT)检测,女性同时检测念珠菌和滴虫。结果男性STD患者GV阳性率为8.1%,居NG(37.3%),UU(22.7%)之后列第3位;女性GV为28.3%,居念珠菌(42.6%),UU(38.6%)之后也列第3位。结论STD患者GV阳性率较高,在检出的病原菌中居第3位,对STD患者应注重GV的检测及治疗。