Granuloma Inguinale (Donovanosis) in Women: An Analysis of 61 Cases from Durban, South Africa

Background and Objectives: Granuloma inguinale (GI) appears to be making a resurgence in South Africa. Local cases were reviewed in order to determine an increasing prevalence and whether differences appeared between pregnant and nonpregnant women. Study Design: Retrospective analysis of clinical records of patients attending a large tertiary teaching hospital, serving an underprivileged population. Results: Sixty-one women with GI were diagnosed over a 3-year period. The most common clinical presentation was genital ulceration in both pregnant (88.5%) and nonpregnant (45.7%) patients. The next most common presentation was genital tract bleeding (19.7%), which occurred mainly among nonpregnant women. The vulva was the most frequent anatomical site involved (54.1%), in both pregnant (88.5%) and nonpregnant (28.6%) women. Multiple sites of infection (vulva, vagina, cervix) occurred only among nonpregnant women. Fourteen of 33 (42.4%) patients whose syphilis serology results were available had reactive tests. Erythromycin and tetracycline were the most common single antimicrobial agents used for therapy and response varied according to site and size of lesion. Conclusions: This study confirms our clinical impression of the increasing prevalence of GI, especially among women in Durban, South Africa. The protean manifestations of the disease are demonstrated with sharp distinctions between pregnant and nonpregnant women and there was a high prevalence of concomitant syphilis.