Donovanosis and HIV infection [1,10,11,12]

Clinical features

Morphology: Longer ulcer duration, greater tissue destruction 

Atypical sites: extra genital sites (chin)

Course
Increased severity, slow healing and treatment failure

Investigation
Tissue smear and biopsy

Therapy

Recommended 

1. Trimethoprim sulfamethoxazoleone double strength tablets 2 times a day or 3 weeks or  until lesions  heal 
2. Doxycycline 100 mg 2 times a day in 3 weeks (or until lesions heal) 

Alternative regimen 

1. Ciprofloxacin 750 mg 2 times a day for 3 weeks (or until lesions heal)
2. Erythromycin 500 mg every 6 hours for 3 weeks (or until lesions heal)
3. Azithromycin 1g orally once per week for atleast 3 weeks.
4. Add Gentamicin 1 mg/kg body weight by slow I/v infusion every 8 hours for 3 weeks (or until lesions heal) if slow healing