1. Reason for surveillance
2. Case definitions
3. Notification criteria and procedure
4. The disease
5. Managing single notifications
6. Managing special situations

1. Reason for surveillance

To monitor the epidemiology and so inform the development of better prevention strategies.

2. Case definitions

Probable case

A probable case requires clinical evidence and epidemiological evidence.

Laboratory evidence

Not applicable.

Clinical evidence

Clinically compatible illness involving genital ulceration.

Epidemiological evidence

• A compatible sexual history in a person from a endemic area, or
• A compatible sexual risk history involving sexual contact with someone from an endemic area.

Confirmed case

A confirmed case requires laboratory definitive evidence and clinical evidence.

Laboratory definitive evidence

• Demonstration of intracellular Donovan bodies on smears or biopsy specimens taken from a lesion, or
• Detection of Calymmatobacterium granulomatis by nucleic acid testing of a specimen taken from a lesion.

Clinical evidence

Clinically compatible illness involving genital ulceration.

Epidemiological evidence

Not applicable.

3. Notification criteria and procedure

Donovanosis is to be notified by laboratories on microbiological confirmation (ideal reporting by routine mail).

Confirmed and probable cases should be entered onto NCIMS.

4. The disease

Infectious agent

The Gram-negative bacillus Klebsiella granulomatis (previously named Calymmatobacterium granulomatis) is the presumed aetiological agent.

Mode of transmission

Presumed to be by direct contact with lesions during sexual activity, but not all sexual partners become infected. It occurs mainly in remote areas of Northern Australia, Papua New Guinea, India and Southern Africa.

Timeline

The typical incubation period is unknown, but probably between 7 and 112 days.

The period of communicability is unknown, but is probably for the duration of the open lesions on the skin or mucous membranes.

Clinical presentation

The usual clinical presentation is characterised by indurated nodules of the external genitalia, inguinal and anal areas which become exuberant, beefy red ulcerated lesions.

5. Managing single notifications

Response times

Data entry

Within 5 working days of notification enter confirmed and probable cases on NCIMS.

Response procedure

Cases under 16 years

• Where a case of donovanosis is reported in a child <16 years old, the PHU must send a letter to the doctor who requested the test to undertake an assessment of the risk of harm according to the mandatory reporting guidelines and obligations under the Children and Young Persons (Care and Protection) Act 1998 and resources for clinical management (Therapeutic Guidelines: Antibiotic).
• Where a case of donovanosis is reported in a child aged 12 years or under, the PHU must also directly contact the doctor (e.g. by telephone) to ensure that mandatory reporting obligations have been addressed. If no contact can be made, the PHU should contact the Child Well Being Unit (1300 480 420) or make a direct report to the Department of Community Services.
• All actions should be documented in the NCIMS record

Case management

Treatment

In general, the attending medical practitioner is responsible for treatment.

Refer to: Therapeutic Guidelines: Antibiotic

Education

In general, the case's doctor provides counselling and education. PHU or Sexual Health Service staff should provide additional assistance, if required. The medical practitioner should provide information to the case about the nature of the infection and the mode of transmission.

Contact management

Identification of contacts

Regular sexual contacts of the patient, the previous weeks and months are at most risk of infection.

Investigation and treatment

The treating doctor is responsible for contact tracing. PHUs should work with SHC staff to provide assistance where requested by the doctor. Contacts require counselling and examination. Most infected contacts will be symptomatic and lesions should be treated.

6. Managing Special Situations

Case clustering

Case clustering, for example among clients of a sex industry establishment, may indicate the need to initiate an education and/or screening program.