Causes

Donovanosis (granuloma inguinale) is caused by the bacteria Klebsiellagranulomatis. The disease is commonly found in tropical and subtropical areas such as Southeast India, Guyana, and New Guinea. However, it can sometimes occur in the United States, typically in the Southeast. There are about 100 cases reported per year in the United States.

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 20-40. The disease is rarely seen in children or the elderly.

Symptoms

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

• About 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 usually painless, but they bleed easily if injured.
• The disease slowly spreads and destroys genital tissue.
• Tissue damage may spread to the area where the legs meet the torso. This area is called the inguinal folds.
• 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

It may be donovanosis if genital sores have been present for a long time and have been spreading.

Tests that may be done include:

• Culture of tissue sample (hard to do and not routinely available)
• Scrapings or punch biopsy of lesion

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. To cure the condition requires long-term treatment. 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

• 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

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.

Alternative Names

Granuloma inguinale

References

Ballard RC. Klebsiella granulomatis (Donovanosis, Granuloma Inguinale). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 236.

Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, HIV infections. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 22.

Workowski KA, Berman SM. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR Recomm Rep. 2010 Dec 17:59:1-110.

Updated: 4/24/2012

Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Jatin M. Vyas, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.