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Clinical Manifestations Of Granuloma Inguinale, Chancroid And Trichomoniasis

Updated on March 24, 2014

Chornic Granulomatous Disease Affecting Genitalis Primarily In Both Sexes


Granuloma Inguinale

Granuloma inguinale is a specific chornic granulomatous disease affecting genitalis primarily in both sexes. It is particularly prevalent in the tropical and subtropical regions. It constitutes 1.5 to 6 % of the total number of STD cases seen in clinics in Africa. There is a higher incidence of this disease in the Southern and Eastern parts of Africa. It has also been reported from India with similar magnitude of occurrence.

The disease is caused by Donovania granulomatis (Calymmato-bacterium granulomatis) which is seen either as bacillary froms inside phagocytes in discharges or biopsy specimens. The organism can be cultured in vitro.

Clinical features: The incubation period ranges from a few days to a few months. The disease starts as a subcutaneous nodule or vesicle which ulcerates to give rise to a granuloma. The lesion extends by contiguity. Draining lymph glands are not affected and this helps in differentiation from a primary chancre. The initial lesions may be in the genitalia, groin, thigh, perineum or oral mucosa depending on the sex practices. It may extend to the buttocks or anterior abdominal wall. In most of the cases, extragenital lesions on the tongue, check, or oral cavity are accompanied by a primary lesion in the genitalia. Fuso-spirochetal infection supervenes as secondary invaders and this results in tissue destruction. The ulcers show pouting granulation tissue. Healing leads to scarring and local elephantiasis of the genitalia. Epidermoid carcinoma may develop in 0.5% of cases.

Diagnosis: Granuloma inguinale has to be differentiated from syphilitic chancre and carcinoma. Diagnosis is confirmed by biopsy and demonstrations of the organism in tissue spreads obtained from the margins of the ulcer.

Treatment: Steptomycin is the drug of choice. It is given as streptomycin sulphate intramuscularly twice daily or four times a day up to a total dose of 20g. Most of the cases respond well. Broad-spectrum antibiotics like tetracycline in doses of 500 mg four times a day for 10 to 15 days, or cotrimoxazole in doses of 1g thrice daily for 7 to 10 days may be given to persons allergic to streptomycin. Late complications may call for surgical measures.

Chancroid Is Caused By Hemophilus decreyi



Chancroid is caused by Hemophilus decreyi. The organism is seen in clusters or singly in smears from ulcers and can be grown in special media. The disease is seen more in poor with bad personal hygiene. Incubation period is 5 days.

Clinical features: Multiple superficial, non indurated, painful ulcers which bleed easily develop along the corona glandis or inner aspect of the labia. Inguinal glands may be enlarged and in may cases they suppurate to form inguinal buboes. Secondary infection with Vincent’s spirochetes may develop. In such cases, balanoposthitis with offensive discharge may be prominent. Diagnosis is confirmed by demonstrating H. ducreyi in Gram stained smears from ulcers or by culture. Other ulcerating lesions have to be excluded.

Treatment: Sulphonamides and streptomycin are effective. Sufadiazine in a dose of 1g thrice daily or a long-acting sulphonamide (sulpha-methoxypyriadazine) 0.5 to 1g twice daily for 10 days is usually curative. Streptomycin 1g daily given intramuscularly for 5 to 10 days is very effective. Tetracyclines are also effective. When the bubo becomes fluctuants, it has to be aspirated through the normal skin in order to be aspirated through the normal skin in order to prevent sinus formation.

Trichomoniasis Is Infection By The Flagellate Protozoan Trichomonas Vaginalis



Trichomoniasis is infection by the flagellate protozoan Trichomonas vaginalis which causes vaginitis in women and rarely urethritis in men. In women, the condition is localized to the vagina. In most cases, infection is acquired by sexual intercourse.

Etiology: The infection is most common in the second and third decades of life and may be associated with gonorrhea. The superficial layers of the vaginal are affected. There is marked polymorpho-nuclear infiltration and changes in the epithelium of the vagina.

Clinical features:

FEMALE: In young women, there is a florid, profuse, irritating, offensive, yellow vaginal discharge. Severe cases may show vulval swelling with excoriation of the adjacent skin. The vaginal pH tends to become more alkaline (pH: 5-8) than normal (pH: 4-5). Symptoms are milder in older women.

MALES: Many are asymptomatic carriers. Some may suffer from true trichomonal urethritis or they may harbor T. Vaginalis in addition to non-gonococcal urethriatis. Occasionally frank purulent urethritis may occur due to this flagellate. Laboratory diagnosis is established by demonstrating the active flagellates in fresh exudates.

Treatment:Metronidazole given orally in a dose of 200 mg thrice daily for 7 days, gives a 96% cure rate. Relapse is prevented by treating both sexual partners simultaneously. Relapses of trichomoniasis are unusual. Recurrence of symptoms is usually due to re-infection.

© 2014 Funom Theophilus Makama


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