Guideline sources The following summarized guidelines for the evaluation and management of granuloma inguinale are prepared by our editorial team based on guidelines from the Center for Disease Control (CDC 1 2021) and the International Union Against Sexually Transmitted Infections (IUSTI/WHO 2010). 2 Guidelines 1. Diagnostic investigations Diagnostic testing: recognize that the causative organism of granuloma inguinale is difficult to culture. E Show 2 more Testing for other STIs: As per CDC 2021 guidelines, test all patients with granuloma inguinale for human immunodeficiency virus. E As per IUSTI 2010 guidelines, obtain testing for human immunodeficiency virus and syphilis in patients with granuloma inguinale. Assessment of sexual partners: https://web.pathway.md/diseases/recwX16CrRdpRlebu 1/3 7/1/23, 12:04 AM Granuloma inguinale Pathway As per CDC 2021 guidelines, evaluate persons having had sexual contact with a patient with granuloma inguinale within the 60 days before onset of the patient's symptoms. E Show 2 more As per IUSTI 2010 guidelines: Recognize that granuloma inguinale is uncommon in partners of index cases. Check sexual contacts in the last 6 months for possible lesions by clinical examination. 2. Medical management Antibiotic therapy: As per CDC 2021 guidelines, administer azithromycin 1 g PO once weekly or 500 mg daily for > 3 weeks and until all lesions have completely healed in patients with granuloma inguinale. E Show 2 more As per IUSTI 2010 guidelines, administer azithromycin 1 g weekly or 500 mg daily as first-line therapy in patients with granuloma inguinale. B Show 3 more 3. Specific circumstances Pregnant patients: As per CDC 2021 guidelines, administer a macrolide regimen (erythromycin or azithromycin) in pregnant and lactating patients with granuloma inguinale. E As per IUSTI 2010 guidelines, consider administering erythromycin 500 mg QID in pregnant patients with granuloma inguinale. C Pediatric patients: Administer a short course of azithromycin 20 mg/kg in pediatric patients with granuloma inguinale. B Administer antibiotic prophylaxis with a 3-day course of azithromycin 20 mg/kg once daily in children born to mothers with granuloma inguinale. B Patients with HIV: administer the same antibiotic regimens in patients with granuloma inguinale and human immunodeficiency virus infection as those used in patients without human immunodeficiency virus infection. E 4. Patient education General counseling: Recognize that patients with granuloma inguinale are often embarrassed or ashamed. Reassure that they have a treatable condition. Ensure that patients take antibiotics until complete healing has been achieved. https://web.pathway.md/diseases/recwX16CrRdpRlebu 2/3 7/1/23, 12:04 AM Granuloma inguinale Pathway 5. Follow-up and surveillance Assessment of treatment response: As per CDC 2021 guidelines: Follow-up patients clinically until signs and symptoms have resolved. E Recognize that relapse can occur 6-18 months after apparently effective therapy. E As per IUSTI 2010 guidelines, perform biopsy to exclude carcinoma if lesions have not resolved by 6 weeks. References 1. Kimberly A Workowski, Laura H Bachmann, Philip A Chan et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70 4 1 187. Open 2. N O'Farrell, H Moi, IUSTI/WHO European STD guidelines Editorial Board. European guideline for the management of donovanosis, 2010. Int J STD AIDS. 2010 Sep;21 9 609 10. Open https://web.pathway.md/diseases/recwX16CrRdpRlebu 3/3