Clinico-epidemiological study of donovanosis in Durban, South Africa
O'Farrell, N.
Genitourinary Medicine 69(2): 108-111
1993
ISSN/ISBN: 0266-4348 PMID: 8509089 DOI: 10.1136/sti.69.2.108Document Number: 331486
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.