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Donovanosis

What Is It, Symptoms, Treatment, and More

Author: Lily Guo

Editors: Ahaana Singh, Lisa Miklush, PhD, RN, CNS

Copyeditor: Joy Mapes

Illustrator: Abbey Richard


What is donovanosis?

Donovanosis, also known as granuloma inguinale, is a sexually transmitted genital ulcer disease. Genital ulcers are lesions, or sores, that can form in the skin around the genitals and mouth, causing destruction of the skin and tissue. Donovanosis is caused by a bacteria called Klebsiella granulomatis, which is typically transmitted through sexual activity and produces generally painless, slow-growing ulcers. 

What causes donovanosis?

The most common cause of donovanosis is sexual exposure to those infected with the Klebsiella granulomatis bacteria. Certain risk factors that can increase the risk of infection include having multiple sexual partners and engaging in unprotected sex. In rare instances, the bacteria may also be transmitted through fecal matter or direct skin-to-skin contact. For this reason, donovanosis can also be seen in young children and adults who are not sexually active. 

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How is donovanosis spread?

Donovanosis is usually spread by sexual contact, and in a small proportion of people, it may be spread by skin-to-skin contact. To prevent the spread of donovanosis, it is important to monitor and maintain good sexual health. This includes avoiding sex with those who have visible ulcers, and using condoms during penetrative sex. 

How common is donovanosis?

Donovanosis can be found in diverse areas of the world, most often in regions with fewer healthcare resources. Geographic areas with high rates of donovanosis include Papua New Guinea and parts of Central America, southern Africa, and southern India. Donovanosis is most common in tropical areas and often affects communities that are impoverished and marginalized. Most infections occur in individuals between the ages of 20 to 40 years old. However, current rates of infection have decreased as a result of public health efforts to limit the spread. 

What is the average incubation period of donovanosis?

The incubation period of donovanosis can range widely -- from 1-4 weeks to as long as a year -- but the signs and symptoms generally appear within a few weeks.

What does donovanosis look like?

The infection usually starts as a firm, raised lump that ulcerates, or becomes red and tender. Genital ulcers are the most common symptom of donovanosis. About 10% of cases feature ulcers in the surrounding groin region, and ulcers may also be seen around the anus and mouth. Very rarely, donovanosis can spread to the bone and liver, often resulting in joint pain or swelling, weight loss, fever, night sweats, or malaise.

There are four types of donovanosis: ulcerogranulomatous, hypertrophic, necrotic, and fibrous. The types are characterized by how the lesions appear. Most commonly, the ulcer becomes ulcerogranulomatous, with a beefy-red appearance and granulation tissue that is highly vascular (i.e., containing many blood vessels). For this reason, these ulcers bleed easily despite being painless. Hypertrophic, or verrucous, ulcers have an irregular edge and can be completely dry, while necrotic ulcers are deeper, foul-smelling, and often painful to the touch. Lastly, fibrous ulcers resemble painless scar tissue. 

How is donovanosis diagnosed?

Donovanosis can be diagnosed by taking a culture of the ulcer using a cotton swab. The swab is then rolled across a slide and stained using Giemsa stain, a common microscopic stain used for diagnosis. Electron microscopy can then be used to look for donovan bodies, which are clusters of dark-staining bacteria seen within large, mononuclear cells. These are microscopic features specific to the bacteria that cause donovanosis. Other techniques that can be used for diagnosis include polymerase chain reaction (PCR), which allows clinicians to identify the specific bacteria in the ulcer based on its DNA, as well as blood tests and biopsies. Biopsies taken from the infected area would show changes in the cell types that indicate inflammation and can confirm diagnosis of donovanosis. 

How is donovanosis treated?

Donovanosis is primarily treated using antibiotics, specifically azithromycin, which stops the growth of bacteria. The ulcers should start healing within days after starting antibiotic therapy. If the infection has persisted for a long time, or if it has progressed to a later stage, antibiotic therapy may need to last several weeks. If the ulcers become secondarily infected with bacteria and are painful, pain medications may also be administered. Even if the symptoms start to subside, the antibiotic course should be completed, and a follow-up visit is usually recommended to make sure the infection is completely healed. Notably, the ulcers from donovanosis can bleed easily and are a known risk factor for the transmission of HIV, which cannot be treated with antibiotics but requires antiretroviral therapy (ART). 

If donovanosis goes untreated, the ulcer will slowly keep growing and may destroy larger areas of healthy skin, cause scarring, and infiltrate the surrounding lymphatic vessels, causing obstruction. Long-standing infection may even be linked to cancer of the genitals. In these situations, surgery may be required to remove the concerning ulcers. 

What are the most important facts to know about donovanosis?

Donovanosis is a sexually transmitted disease caused by the bacteria Klebsiella granulomatis. There are four types of donovanosis: ulcerogranulomatous, hypertrophic, necrotic, or fibrous. Most commonly, donovanosis leads to growth of beefy-red, slow-growing, typically painless ulcers in the genital, groin, and anal area. These ulcers can bleed easily to the touch, and if left untreated, they can spread via lymphatic vessels to surrounding areas, as well as to bone and the liver. 

Donovanosis is common in tropical areas of the world that have fewer healthcare resources. Diagnosis may involve using stains, microscopy, blood tests, and biopsies. If diagnosis is confirmed, donovanosis can be treated and cured with the use of antibiotics. Those who are sexually active are recommended to wear condoms and to avoid sex with those who have visible ulcers to prevent transmission of this infectious disease.

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Related links

Bacterial structure and functions
Sexuallly transmitted infections: Clinical practice

Resources for research and reference

Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. (2015, June 4). Granuloma inguinale (donovanosis). In Centers for Disease Control and Prevention: 2015 sexually transmitted diseases treatment guidelines. Retrieved December 12, 2020, from https://www.cdc.gov/std/tg2015/donovanosis.htm

Hart, G. (1997). Donovanosis. Clinical Infectious Diseases, 25(1): 24-30. Doi: 10.1086/514495

O’Farrell, N. (2002). Donovanosis. Sexually Transmitted Infections, 78: 452-457. Retrieved December 11, 2020, from https://sti.bmj.com/content/78/6/452 

Rishi, A., & Cornish, T. (2020, November 16). Granuloma inguinale. In PathologyOutlines.com. Retrieved January 25, 2021, from https://www.pathologyoutlines.com/topic/anusgranulomainguinale.html