Page content: Victorian statutory requirement | Infectious agent | Identification | Incubation period | Public health significance & occurrence | Reservoir | Mode of transmission | Period of communicability | Susceptibility & resistance | Control measures | Outbreak measures | Additional sources of information

Victorian statutory requirement

Donovanosis (Group C disease) requires written notification within five days of the initial diagnosis.

Specific information must be notified under the Health (Infectious Diseases) Regulations 2001. To maintain confidentiality, only the name code (first two letters of the surname followed by the first two letters of the first name) is required.
Medical practitioners have a statutory obligation under the Children and Young Person’s Act 1989 to notify the Department of Human Services Child Protection Service if they believe that a child is in need of protection on the basis of sexual abuse.

Infectious agent

Previously known as Calymmatobacterium granulomatis, a gram-negative bacillus, the causative agents is now named Klebsiella granulomatis.

Identification

Clinical features
Donovanosis is a chronic, progressively destructive infection which affects the skin and mucous membranes of the external genitalia, inguinal and anal regions. Disseminated disease is uncommon but may be life threatening and so should be considered in patients from endemic areas. It presents initially as raised, ‘beefy’ nodules or sores. Lesions may extend peripherally with characteristic rolled edges. Local spread to pelvic and abdominal structures occurs and dissemination to distant sites can also occur.

Method of diagnosis
The diagnosis is confirmed by demonstrating ‘Donovan bodies’ in Wright or Giemsa-stained smears of granulation tissue or by histological examination of biopsy specimens.

Incubation period

The incubation period is weeks to months.

Public health significance & occurrence

Donovanosis is rare in industrialised countries but endemic in some tropical and subtropical countries and areas including northern Australia.

There have been no cases of donovanosis notified in Victoria since at least 1992.

Reservoir

Humans.

Mode of transmission

Transmission is primarily sexual. It is possible that some cases are transmitted non-sexually.

Period of communicability

The period of communicability is unknown but may be months to years.

Susceptibility & resistance

Everyone is susceptible to infection.

Control measures

Preventive measures
Preventative measures include education about safe sex practices including use of condoms and early detection of infection by testing of people at risk.

Control of case
First-line treatment for donovanosis is azithromycin. Treatment should be directly observed. Follow-up is important as resolution may be slow and recurrence may occur.

Control of contacts
Sexual contacts should be examined for possible infection. The likelihood of transmission per act of unprotected intercourse is considered to be low and the likelihood of a long term partner being infected is low to moderate. Contacts dating back weeks or months should be traced according to the sexual history.

Control of environment
Not applicable.

Outbreak measures

Not applicable.

Additional sources of information

• Australian Government Department of Health and Family Services 1998, Contact tracing manual – a practical handbook for health care providers managing people with HIV, viral hepatitis, other STDs and HIV-related tuberculosis.
• Carter, JS, Bowden, FJ, Bastian, I, Myers, GM, Sriprakash, KS, Kemp, DJ 1999, ‘Phylogenetic evidence for reclassification of Calymmatobacterium granulomatis as Klebsiella granulomatis’, International Journal of Systemic Bacteriology, vol. 49, pp. 1695–700.
• Venereology Society of Victoria 2002, National management guidelines for sexually transmissible infections, Venereology Society of Victoria