Donovanosis (granuloma inguinale)

  • Definition
    • Donovanosis (granuloma inguinale) is a sexually transmitted disease that is rarely seen in the United States.

  • Alternative Names
    • Granuloma inguinale; Sexually transmitted disease – donovanosis; STD - donovanosis; Sexually transmitted infection – donovanosis; STI - donovanosis

  • Causes
    • Donovanosis (granuloma inguinale) is caused by the bacteria Klebsiella granulomatis. The disease is commonly found in tropical and subtropical areas such as southeast India, Guyana, and New Guinea. There are about 100 cases reported per year in the United States. Most of these cases occur in people who have traveled to or are from places where the disease is common.

      The disease spreads mostly through vaginal or anal intercourse. Very rarely, it spreads during oral sex.

      Men are affected more than twice as often as women. Most infections occur in people ages 20 to 40.

  • Symptoms
    • Symptoms can occur 1 to 12 weeks after coming in contact with the bacteria that cause the disease.

      • About one half of infected men and women have sores in the anal area.
      • Small, beefy-red bumps appear on the genitals or around the anus.
      • The skin gradually wears away, and the bumps turn into raised, beefy-red, velvety nodules called granulation tissue. They are often painless, but they bleed easily if injured.
      • The disease slowly spreads and destroys genital tissue.
      • Tissue damage may spread to the groin.
      • The genitals and the skin around them lose skin color.

      In its early stages, it may be hard to tell the difference between donovanosis and chancroid.

      In the later stages, donovanosis may look like advanced genital cancers, lymphogranuloma venereum, and anogenital cutaneous amebiasis.

  • Exams and Tests
    • Tests that may be done include:

      Laboratory tests, such as those used to detect syphilis, are available only on a research basis for diagnosing donovanosis.

  • Treatment
    • Antibiotics are used to treat donovanosis. These may include azithromycin, doxycycline, ciprofloxacin, erythromycin, and trimethoprim-sulfamethoxazole. To cure the condition, long-term treatment is needed. Most treatment courses run 3 weeks or until the sores have completely healed.

      A follow-up examination is important because the disease can reappear after it seems to be cured.

  • Outlook (Prognosis)
    • Treating this disease early decreases the chances of tissue damage or scarring. Untreated disease leads to damage of the genital tissue.

  • Possible Complications
    • Health problems that may result from this disease include:

      • Genital damage and scarring
      • Loss of skin color in genital area
      • Permanent genital swelling due to scarring
  • When to Contact a Medical Professional
    • Call for an appointment with your health care provider if:

      • You have had sexual contact with a person who is known to have donovanosis
      • You develop symptoms of donovanosis
      • You develop an ulcer in the genital area
  • Prevention
    • Avoiding all sexual activity is the only absolute way to prevent a sexually transmitted disease such as donovanosis. However, safer sex behaviors may reduce your risk.

      The proper use of condoms, either the male or female type, greatly decreases the risk of catching a sexually transmitted disease. You need to wear the condom from the beginning to the end of each sexual activity.

  • References
    • Ballard RC. Klebsiella granulomatis (donovanosis, granuloma inguinale). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 237.

      Richens J. Granuloma inguinale. In: Magill AJ, Hill DR, Solomon T, Ryan ET, eds. Hunter's Tropical Medicine and Infectious Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 52.