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.
PIP: In 1988, in South Africa, staff at the City Health STD Clinic at King Edward VIII Hospital in Durban took tissue smears from 130 men and 41 women to study the epidemiological and clinical features of donovanosis as it relates to a possible risk of HIV-1 transmission. Laboratory personnel used the RapiDiff staining method and histological examinations to detect Donovan bodies in 169 and 2 of the patients, respectively. 96% of patients were 16-39 years old. 55.6% came from rural areas. Lesions were mainly limited to the genital area (96.2% for men and 78% for women). Women were more likely to also have lesions in the inguinal area (17.1% vs. 1.5%). Most donovanosis lesions were ulcero-granulomatous (96.2% for men and 90.2% for women). 3 of the 6 pregnant female patients had hypertrophic lesions. The only case of anal donovanosis was a woman. Even though the patients had ulcers, many continued to have sexual intercourse. 55.4% of the men and 46.3% of the women had ulcers for more than 28 days before coming to the clinic. 40 patients with donovanosis (23%) also had syphilis. Donovanosis was diagnosed in just 1 of 21 regular sexual partners examined. 2 tablets of co-trimoxazole 2 times daily for, mostly, 14 days cured 41 (24%) patients who returned to the clinic for follow-up. Pregnant women took 500 mg of erythromycin 2 times a day. A few cases had to take 100 mg minocycline twice a day. 4 men tested positive for HIV-1 antibodies while none of the women did. 3 of the HIV-1 positive men who returned to the clinic were completely cured of donovanosis. None of these men had HIV-related symptoms. They were treated with co-trimoxazole. These findings suggest that rural health facilities are not adequately serving patients with donovanosis. Since genital ulcer disease, such as donovanosis, facilitates transmission of HIV-1, strategies to curb the spread of HIV should consider specific measures aimed at eradicating donovanosis in areas where it is prevalent.