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 bacterium 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.

Most infections occur in people ages 20 to 40.

Symptoms

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

These may include:

• Sores in the anal area in about half of the cases.
• 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:

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

Laboratory tests, similar to 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.

Images

References

Gardella C, Eckert LO, Lentz GM. Genital tract infections: vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier Saunders; 2017:chap 23.

Ghanem KG, Hook EW. Granuloma inguinale (Donovanosis). In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier Saunders; 2020:chap 300.

Stoner BP, Reno HEL. Klebsiella granulomatis (donovanosis, granuloma inguinale). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier Saunders; 2020:chap 235.