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Donovanosis (Granuloma inguinale): Symptoms and Treatment

Definition

Donovanosis is a sexually transmitted disease with Klebsiella granulomatis, leading to progressive, painless genital ulcers.

Epidemiology of Donovanosis

With declining prevalence, sporadic donovanosis occurs in Papua New Guinea, South Africa, India, and Brazil.

Etiology

The pathogen of donovanosis is Klebsiella granulomatis (old nomenclature Calymmatobacterium granulomatis), a gram-negative and intracellular bacteria.

Signs and Symptoms of Donovanosis

The incubation period is around 50 days. Donovanosis presents with progressive, painless, highly vascular genital ulcers without inguinal lymphadenopathy. The genital ulcers are destructive and can affect the genital organs, the groin, and the perineal region.

Diagnosis

Biopsy from the base of the ulcer shows dark-staining Donovan bodies within large mononuclear cells. NAAT swab tests should rule out chancroid.

Differential Diagnosis

Chancroid and penile tumors.

Treatment of Donovanosis

• First choice is Azithromycin 1 g p.o. per week for at least three weeks until complete healing of the ulcers.
• Doxycyclin (100 mg 1-0-1), Cotrimoxazol (160/800 mg 1-0-1) or Erythromycin (500 mg 1-1-1-1) are further alternatives.

References

Center for Disease Control and Prevention: “Sexually Transmitted Infections (STI) Treatment Guidelines,” 2021. [Online]. Available: https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf

IUSTI, “European guideline on donovanosis,” 2016. [Online]. Available: https://iusti.org/wp-content/uploads/2019/12/Donovanosis2016.pdf

  Deutsche Version: Granuloma inguinae