Granuloma inguinale

Granuloma inguinale usually begins as painless papules or nodules in the genital or perianal region, which slowly evolve into chronic ulcers with raised, well-defined edges and a fleshy appearance. The lesions are highly vascularized and tend to bleed upon touch, but without significant pain, which helps differentiate them from genital infections such as genital herpes or chancroid, which are generally painful. Another characteristic that differentiates it from other sexually transmitted infections is the absence of significant regional lymphadenopathy. When lymph nodes do enlarge, they are usually small and non-suppurating, unlike what occurs, for example, in lymphogranuloma venereum. Ulcers from granuloma inguinale tend to be progressive and, if left untreated, can coalesce and lead to extensive tissue destruction, with potential genital deformity. Because they present an insidious evolution and exuberant appearance, they can often be confused with neoplasms, especially squamous cell carcinoma, or with long-lasting syphilitic lesions.