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Granuloma inguinale

Guidelines

Key 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 2021) and the International Union Against Sexually Transmitted Infections (IUSTI/WHO 2010).
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Diagnostic investigations

Diagnostic testing: as per CDC 2021 guidelines, recognize that the causative organism of granuloma inguinale is difficult to culture.
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  • Testing for other STIs

  • Assessment of sexual partners

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.
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Specific circumstances

Pregnant patients: as per CDC 2021 guidelines, administer a macrolide regimen (erythromycin or azithromycin) in pregnant and lactating patients with granuloma inguinale.
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  • Pediatric patients

  • Patients with HIV

Patient education

General counseling
As per IUSTI/WHO 2010 guidelines:
Recognize that patients with granuloma inguinale are often embarrassed or ashamed. Reassure that they have a treatable condition.
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Ensure that patients take antibiotics until complete healing has been achieved.
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Follow-up and surveillance

Assessment of treatment response
As per CDC 2021 guidelines:
Follow-up patients clinically until signs and symptoms have resolved.
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Recognize that relapse can occur 6-18 months after apparently effective therapy.
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