Cervix
Inflammation / parasite
Granuloma inguinale



Topic Completed: 1 January 2015

Revised: 26 December 2019

Revised: 21 December 2018, last major update January 2015

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Granuloma inguinale [title] cervix

John K.S.S. Philip, M.D.
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Cite this page: Philip J. Granuloma inguinale. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cervixgranulomainguinale.html. Accessed January 25th, 2020.
Definition / general
  • Sexually transmitted infection caused by gram negative rod Klebsiella granulomatis, formerly called Calymmatobacterium granulomatis, which has characteristic bipolar staining
  • Sexually transmitted disease which affects genital skin and mucosa and causes inguinal lymphadenopathy; rarely becomes disseminated
  • May occur in children of infected mothers via birth canal (Am J Clin Pathol 1997;108:510)
  • May mimic carcinoma (Genitourin Med 1990;66:380)
Terminology
  • Also called granuloma venereum, donovanosis
Epidemiology
  • Endemic in tropical and developing areas, including India, Guyana, New Guinea, central Australia, southern Africa
  • Rare in USA and Europe
Sites
  • Anogenital skin, rarely oral mucosa or pharynx
  • In females, vulva and perianal area are frequent sites; only rarely affects uterus, fallopian tubes, ovaries
Etiology
  • Due to Klebsiella granulomatis, an intracellular gram negative coccobacillus, previously termed Calymmatobacterium granulomatis and Donovania granulomatis
Clinical features
Diagnosis
  • Microscopic examination of smears from ulcer base or histologic sections of ulcer is preferred
  • Culture is difficult to perform and not routinely available
    • Does not grow on artificial solid media but has been cultured in chicken embryonic yolk sacs, on human monocytes and on human epithelial (Hep - 2) cells
  • A serologic test, based on indirect immunofluorescence, is more useful in confirming the diagnosis in long - standing lesions, less useful in early disease
  • A diagnostic PCR test has been developed
  • Electron microscopic examination may be helpful
Case reports
Treatment
  • Doxycycline 100 mg orally twice a day for at least 3 weeks and until all lesions have completely healed (CDC - Granuloma Inguinale)
Microscopic (histologic) description
  • Inflammatory cells, mainly neutrophils and some macrophages
  • Plump histiocytes with thin walled vacuoles containing multiple bacteria
  • Bacteria appear as straight or curved dumbbell shaped rods with prominent bipolar granules (Donovan bodies), resembling a "safety pin"
  • This classic "safety pin" appearance is more evident in Giemsa stain and not so apparent in alcohol fixed smears
  • Epithelioid histiocytes may be seen, but giant cells are not seen (Pantanowitz: Cytopathology of Infectious Diseases, page 106)
  • Relative paucity of epithelial cells
  • Intact capillaries may be seen in scrapings and conventional pap smears (Diagn Cytopathol 1986;2:138)
Positive stains
Negative stains
Electron microscopy description
Differential diagnosis
  • Follicular cervicitis: accompanying inflammatory infiltrate is lymphoid predominant and not neutrophilic
  • Malakoplakia: Michaelis-Gutmann bodies are more dense and round with concentric lamination, compared with donovan bodies (Cytopathology 1991;2:271)
Additional references
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