This protocol applies to patients with granuloma inguinale (donovanosis) who are pregnant and have completed an azithromycin course without reaching the treatment target — complete healing of the genital ulcers — at the three-week reassessment point.
Granuloma inguinale during pregnancy requires antibiotic selection that is appropriate for the pregnant patient. The primary treatment goal throughout is complete healing of the genital ulcers, assessed at three weeks.
When azithromycin (given weekly or daily for at least three weeks) has not resulted in complete healing of the genital ulcers at the three-week reassessment, the clinical situation warrants a change in antibiotic therapy. This protocol defines the alternative approach for that scenario.
The next-line regimen involves an erythromycin-based antibiotic, chosen for its suitability in pregnancy. The specific dosing schedule and duration are defined in the full protocol. The treatment target remains complete healing of the genital ulcers.