Studies On Granuloma Inguinale-VII: VII. SOME EPIDEMIOLOGICAL CONSIDERATIONS OF THE DISEASE

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Abstract
Modes of transmission of granuloma inguinale are discussed. Factors suggesting sexual transmission are listed and analysed: history of sexual exposure before appearance of lesion; increased incidence in age groups in which sexual activity is highest; lesions on internal genitalia such as the cervix without any other lesions; lesions around the anal orifice inpatients who practicepassivepederasty; and genital or peri-genital location of lesions. the commonest site being on or about the external genitalia. Data suggesting other than verereal transmission are: occurrence in very young children and sexually inactive persons; rarity in prostitutes; occurrence of non-genital lesions in both homosexuals and heterosexuals; and rarity of the disease in the sexual partners of patients with active open lesions. Final evaluation suggests that granuloma inguinale is not usually a venereal disease, but is a specific, granulomatous reaction in the skin of the host to the presence of a bacterium, Donovania granulomatis. The cellular response of the host to the presence of the Donovania is indicated by the production or migration of monocytes into the area of involvement. Though the normal habitat of the Donovania is the intestine where it apparently causes no pathologic changes, when conditions are appropriate and the bacterium is introduced into the skin (by fecal pollution and sexual or non-sexual trauma or infection) clinical lesions are initiated. It is suggested that auto-inoculation may be associated with coitus or with non-coital trauma. Before coitus Donovania may be mechanically transferred from the intestine to the genital area and during sexual activity the bacterium may be introduced into the skin. This would not be venereal transmission in the strict sense, for the transfer is not from patient to patient. In auto-inoculation not associated with coitus, it is possible for the bacteria to be introduced by fecal pollution, non-sexual trauma or infection.