InternationalJournal of Gynecology & Obstetrics 53 (1996) 133-138 I*nulkul&umld GYNEtOLoGY & OBSTETRICS Article Granuloma inguinale in association with pregnancy and HIV infection A.A. Hoosen*a, M. Mphatsoeb, A.B.M. Kharsanya, J. Moodleyb, A. Bassab, A. Bramdevb ‘Department of Medical Microbiology, Foctdty of Medicine, University of Natal, Durban, South Africa bDepartment of Obstetrics and Gynaecology, MRC Pregnancy Hypertension Research Unit, Faculty of Medicine, University of Notol, Durban, South Africa =Departmentof Anaiomicol Pothology, Focul~yof Medicine, University of Natal, Durban, South Africa Received 11September 1995; revised15December 1995; accepted 20 December 1995 Abstract Objectives: A retrospective study to confirm the clinical impression of an increasing prevalence of granuloma in- guinale (GI) in women, and to evaluate its association with pregnancy and HIV infection. Method: Clinical records of all patients with a definitive diagnosis of GI attending the gynecology and antenatal clinics at King Edward VIII Hospital, Durban, South Africa, over a period of 36 months (January 1991-December 1993). Results: A total of 123 women were diagnosed with GI. The diagnosis was made by tissue smearalone in 21% (n = 26), histology 43% (n = 53) and by a combination of smearand histology in the rest. Forty-two percent (n = 52) were pregnant. The only difference betweenpregnant and non-pregnant women were the presence of rectal and pelvic lesions in the latter. Sixty-nine per- cent (n = 36) delivered vaginally while the remaining (n = 16) were delivered by cesareansection. The indications for cesarean section were obstetric except for a patient in labor with extensive untreated vulva1 granuloma. In the majority (85%) GI had no influence on pregnancy outcome. There was no evidence of congenital GI in the neonates. Twenty- seven percent (30/l 13)had positive syphilis serology and 16%(18/l 10) had antibody to HIV. There were no differences in the clinical features and outcome of HIV positive and negative women. Conclusion: This study shows that GI is in- creasing in pregnancy in Durban, South Africa. Despite the concern that pregnancy promotes dissemination of GI, such an effect could not be established as the clinical response to treatment and outcome were similar in both pregnant and non-pregnant women. Infection with HIV also did not alter the clinical presentation and outcome of the disease in the patients studied. Keywords: Granuloma inguinale; Donovanosis; Pregnancy; HIV infection 1. Introduction Granuloma inguinale (GI) or Donovanosis is a chronic granulomatous genital infection causedby an intracellular Gram negative bacillus, Calym- l Corresponding author. matobacterium granulomatis. This condition is generally considered to be sexually transmitted and is found in specific geographic foci, e.g.-Papua New Guinea, India, Central Australia and the Caribbean [ 11. In recent years, KwaZuWNatal has emergedas an endemic area [2-31. Clinically, GI manifests in many different forms 0020-7292/96/$15.00 0 1996 International Federation of Gynecology and Obstetrics PII 0020-7292(96)02648-3