The changing epidemiology of genital ulcer disease in South Africa: has donovanosis been eliminated?

Abstract

ObjectivesWe used an in-house molecular assay for the detection of Klebsiella granulomatis in ulcer specimens collected over a 12-year surveillance period in order to determine whether a diagnosis of donovanosis could be ascribed to genital ulcer disease (GUD) of unknown aetiology in our setting.MethodsBetween 2007 and 2018, a total of 974 genital ulcer specimens with no previously identified sexually transmitted (STI) pathogens were selected from STI aetiological surveys conducted in all nine provinces of South Africa. Giemsa-stained ulcer smears from the same participants had previously been routinely analysed for the presence of typical Donovan bodies within large mononuclear cells. A Klebsiella screening assay targeting the phoE (phosphate porin) gene was used in combination with restriction digest analysis and sequencing to confirm the presence of K. granulomatis.ResultsThe Klebsiella screening assay tested positive in 19/974 (2.0%) genital ulcer specimens. Restriction digest analysis and nucleotide sequencing of the phoE gene confirmed that none of these specimens was positive for K. granulomatis DNA. Similarly, Donovan bodies were not identified in the Giemsa stained ulcer smears of these specimens.ConclusionsThis is the first study to assess K. granulomatis as a cause of genital ulceration in South Africa over a 12-year surveillance period using molecular methods. The results demonstrate that K. granulomatis is no longer a prevalent cause of GUD in our population.

Southern African HIV Clinicians Society 2022 guideline for the management of sexually transmitted infections: Moving towards best practice

“…Lymphogranuloma venereum (LGV) caused by C. trachomatis biovars L1-L3, chancroid (Haemophilus ducreyi), and donovanosis (Klebsiella granulomatis) have become uncommon in the last decade. 14,35,36 First-line syndromic regimen for GUD should include medications to treat HSV and syphilis (Table 3). Acyclovir is the medication of choice for HSV while benzathine benzylpenicillin, also called benzathine penicillin G (BPG), is the cornerstone of syphilis treatment.…”

“…Lymphogranuloma venereum (LGV) caused by C. trachomatis biovars L1–L3, chancroid ( Haemophilus ducreyi ), and donovanosis ( Klebsiella granulomatis ) have become uncommon in the last decade. 14 , 35 , 36 …”

Etiological Surveillance of Genital Ulcer Syndrome in South Africa: 2019 to 2020

“…4 Although granuloma inguinale (donovanosis) accounted for a significant proportion of genital ulceration seen in KwaZulu Natal province in the latter part of the 20th century, this condition has been virtually eliminated and has not been reported in recent years. 5 The Centre for HIV & STI at the National Institute for Communicable Diseases (NICD) has been conducting STI etiological surveillance since 2007 to revise and update national syndromic management guidelines in use at PHCs throughout the country. From 2019 to 2020, surveillance was conducted at 3 sentinel sites in 3 provinces: Gauteng, Western Cape, and KwaZulu Natal (KZN).…”

Aetiology of genital ulcer disease and associated factors among Mthatha public clinic attendees

“…11 Klebsiella granulomatis was not detected in this study, a finding similar to a previous study that was conducted among the South African population that also reported negative Klebsiella granulomatis in genital ulcer specimens. 39 The negative results are probably because of public recognition of Donovanosis as a health problem with control measures or as a result of the improvement of health services or living standards. 14 Haemophilus ducreyi was the third-highest ulcerating pathogen in this study.…”