Donovanosis in a child victim of sexual abuse: response to doxycycline treatment

Magalhães, Bárbara Machado; Veasey, John Verrinder; Mayor, Silvia Assumpção Soutto; Lellis, Rute Facchini

doi:10.1590/abd1806-4841.20187948

Cited by 8 publications

(5 citation statements)

References 7 publications

(6 reference statements)

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“…Granuloma inguinale (donovanosis) is a genital ulcerative disease caused by the intracellular gram-negative bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). The disease occurs rarely in the United States; however, sporadic cases have been described in India, South Africa, and South America (526)(527)(528)(529)(530)(531)(532)(533)(534)(535). Although granuloma inguinale was previously endemic in Australia, it is now extremely rare (536,537).…”

Section: Granuloma Inguinale (Donovanosis)mentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,588

2,621

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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

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Section: Granuloma Inguinale (Donovanosis)mentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,588

2,621

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“…The decentralisation of STI services in South Africa after this epidemic resulted in the cessation of laboratory testing for donovanosis, with no prevalence data reported in the late 1990s and early 2000s 15. Current global prevalence data for donovanosis is sparse and are mainly limited to isolated cases reported in the literature 16–21. It is important to note that participants enrolled at sentinel sites in Kwa-Zulu Natal (n=174) and Mpumalanga (n=78) for our study, were recruited from within a 50 km radius of areas that were previously endemic for donovanosis.…”

Section: Discussionmentioning

confidence: 99%

The changing epidemiology of genital ulcer disease in South Africa: has donovanosis been eliminated?

Müller¹,

Kularatne

2020

Sex Transm Infect

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ObjectivesWe used an in-house molecular assay for the detection of Klebsiella granulomatis in ulcer specimens collected over a 12-year surveillance period in order to determine whether a diagnosis of donovanosis could be ascribed to genital ulcer disease (GUD) of unknown aetiology in our setting.MethodsBetween 2007 and 2018, a total of 974 genital ulcer specimens with no previously identified sexually transmitted (STI) pathogens were selected from STI aetiological surveys conducted in all nine provinces of South Africa. Giemsa-stained ulcer smears from the same participants had previously been routinely analysed for the presence of typical Donovan bodies within large mononuclear cells. A Klebsiella screening assay targeting the phoE (phosphate porin) gene was used in combination with restriction digest analysis and sequencing to confirm the presence of K. granulomatis.ResultsThe Klebsiella screening assay tested positive in 19/974 (2.0%) genital ulcer specimens. Restriction digest analysis and nucleotide sequencing of the phoE gene confirmed that none of these specimens was positive for K. granulomatis DNA. Similarly, Donovan bodies were not identified in the Giemsa stained ulcer smears of these specimens.ConclusionsThis is the first study to assess K. granulomatis as a cause of genital ulceration in South Africa over a 12-year surveillance period using molecular methods. The results demonstrate that K. granulomatis is no longer a prevalent cause of GUD in our population.

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“…6,8,18 Although it is not usual to assign greater importance to this protozoan in other circumstances, in pregnant women who suffer sexual violence it may be related to infection with preterm labour, premature rupture of membranes and low birth weight. 12 Magalhães et al 37 report the case of an 11-year-old female victim of chronic sexual abuse. The donovanosis is a chronic sexually transmitted infectious caused by the Gram-negative bacteria Klebsiella granulomatis, endemic in tropical and subtropical regions.…”

Section: Discussionmentioning

confidence: 99%

Sexually Transmitted Infections Among Adolescent and Adult Women Victims of Sexual Violence in the Metropolitan Region of São Paulo, Brazil

Drezett¹,

Bessa²,

Valenti³

et al. 2020

Hum. Reprod. Arch.

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Background: Sexual violence is a serious violation of human rights that mainly affects women. Among the impacts on health, sexually transmitted infections (STIs) are important due to their high prevalence and possible reproductive harm. Objective: To check and compare the incidence of STIs in adolescent and adult women victims of sexual violence. Method: Retrospective cohort study with 135 adolescents (10-19 years) and 154 adult women (≥20 years) attending the Pérola Byington Hospital, São Paulo, Brazil, with vaginal and/or anal unprotected exposure during the sexual crime, with ingression between 72 hours and 10 days of the violence, who did not receive prophylaxis for STIs, hepatitis B or HIV. Cases with earlier STIs, pregnant women and violence from an intimate partner were excluded. The outcome was the occurrence of STIs in the two groups. Data were introduced in the program Epi Info6, version 6.04b, with statistical analysis by chi-square test. Results: The diagnosis of STIs occurred for 32.6% of adolescents and 31.1% of adult women. The median age was 21.0±5.8 years. Adolescents were more vulnerable to the related and known aggressors. Ninety-two patients with STIs (31.8%) were found along with 120 infections among the 289 women, distributed between HPV (16.9%), trichomoniasis (6.6%), chlamydia (3.8%), herpes (2.4%), hepatitis B (2.4%), syphilis (2.1%), gonorrhea (1.7%) pelvic inflammatory disease (1.7%), hepatitis C (1.4%), HIV (1.4%) and HTLV I and II (1.0%). Conclusion: The incidence and distribution of STIs show no differences in the two groups, suggesting similar risk for adolescent and adult women when submitted to the same forms of exposure during sexual crime.

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Donovanosis in a child victim of sexual abuse: response to doxycycline treatment

Cited by 8 publications

References 7 publications

Sexually Transmitted Infections Treatment Guidelines, 2021

Sexually Transmitted Infections Treatment Guidelines, 2021

The changing epidemiology of genital ulcer disease in South Africa: has donovanosis been eliminated?

Sexually Transmitted Infections Among Adolescent and Adult Women Victims of Sexual Violence in the Metropolitan Region of São Paulo, Brazil

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