Donovanosis: Definition, causes, symptoms, treatment - Medical News Today

Donovanosis is an infection with the bacterium Klebsiella granulomatis. It affects the genital region, causing red, painless ulcers that bleed easily. People usually acquire the infection through sexual contact.

Donovanosis describes an ulcerative condition, meaning that it results in breaks in the skin that do not heal naturally. Due to the appearance of these lesions, some people may refer to donovanosis as a "flesh-eating" infection. However, this is incorrect because the bacteria do not eat the flesh.

An infection of K. granulomatis, previously known as Calymmatobacterium granulomatis, causes donovanosis. The infection, which some people may refer to as granuloma inguinale, is more common in tropical or subtropical areas.

Donovanosis is a sexually transmitted infection (STI), with people often acquiring it through sexual activity that involves direct contact with sores.

In this article, we discuss what donovanosis is, its symptoms, and how a person might acquire it. Additionally, we explore prevention tips and treatment options.

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Image displaying Donovan bodies, which are associated with Klebsiella granulomatis.
CDC/ Susan Lindsley

Donovanosis is a bacterial infection that the bacterium K. granulomatis causes. Its name derives from Donovan bodies, which are cells present in people with the infection.

The hallmark of donovanosis is ulcerative lesions in the genital region or the space between the anus and the genitals, which is called the perineum. Ulcerative lesions are breaks on the surface of the skin that extend into the underlying tissue. A doctor may see Donovan bodies under a microscope after taking skin scrapings from the ulcerative lesions.

Donovanosis is an STI. The infection typically spreads through sexual contact, which can include vaginal, anal, and, rarely, oral sex.

Donovanosis can also spread to a newborn during childbirth if the bacteria are present in the genital tract and the newborn encounters the bacteria. However, this is very rare. In some cases, donovanosis may also transmit from skin-to-skin contact. The majority of donovanosis cases occur among people aged 20–40 years.

The infection is rare in the United States, where there are only about 100 reported cases of donovanosis each year. Donovanosis is more prevalent in tropical and subtropical countries, including:

• Papa New Guinea
• the southern region of India
• Southern Africa
• the Caribbean
• South America
• the remote Northern region of Australia
• Guyana

There have also been reports of cases of donovanosis in the United Kingdom. According to Public Health England, there were 30 reported cases of donovanosis in 2019.

A person can reduce their risk of donovanosis infection and transmission by using barrier methods, such as condoms, during sexual activity. They can also refrain from having sex with someone with active symptoms of donovanosis.

Certain risk factors can increase the likelihood of acquiring a donovanosis infection. These include:

• having multiple sexual partners
• being aged 20–40 years
• undergoing STI testing too infrequently
• living in or traveling to a region that has a higher incidence of donovanosis
• having sex without using barrier methods
• other factors, such as poorer hygiene and low socioeconomic status

Symptoms usually occur 1–12 weeks after infection. Some sources suggest that it may take an average of 50 days for symptoms to become apparent, but the time can vary from a few days to up to a year.

The most common symptom of donovanosis is the presence of slow-growing ulcerative lesions. The ulcerative lesions usually begin as small papules or nodules under the skin and then ulcerate to resemble sores. These ulcerative lesions are present in the genital region and may also appear around the anus, perineum, or mouth.

The painless ulcers have what some individuals may describe as a beefy red appearance and may bleed. The borders of the ulcers can also have a "snake-like" appearance.

Four types of lesions can occur:

• Ulcerogranulomatous or ulcero-vegetative lesions: These are the most common type. They have a beefy red, non-tender appearance and bleed easily.
• Hypertrophic or verrucous lesions: These lesions have irregular raised edges and a dry texture. Some people refer to these lesions as having a walnut-like appearance.
• Necrotic lesions: These lesions, which have a foul smell, are deep and cause tissue destruction.
• Sclerotic or cicatricial lesions: These lesions include fibrous and extensive plaques of scar tissue.

Some sources may also describe:

• Nodular lesions: These are less common than the ulcero-vegetative type and typically consist of papules and nodules that are soft and red. They may also present with some granulation tissue.
• Elephantiasis manifestations: These primarily affect females and involve the formation of scar tissue. This complication can occur with long lasting ulcers.

A doctor will usually take skin scrapings from the lesions to observe the cells under a microscope. Although it is difficult to culture K. granulomatis, the presence of Donovan bodies helps doctors diagnose the condition.

These appear as dark-staining cells on a tissue crush preparation or biopsy. Although there is currently no approved test for detecting the bacterium, lab technicians may use molecular assays to help identify the causative agent.

As K. granulomatis is the causative agent of donovanosis, a doctor can treat the infection with antibiotics.

The Centers for Disease Control and Prevention (CDC) recommend that people with donovanosis take the antibiotic azithromycin (Zithromax) at a dose of 1 gram once a week or 500 milligrams daily. They should take the medication for more than 3 weeks and until all lesions have completely healed.

Alternative medications that the CDC recommends include:

In some cases, a doctor may prescribe an additional antibiotic if there is no improvement of symptoms within the first few days of treatment. The CDC also recommends that anyone who receives a diagnosis of donovanosis test for HIV.

It is advisable for a person to stop all sexual contact if they receive a donovanosis diagnosis. They should only resume sexual intercourse once they have completed treatment and when a doctor has told them that it is safe to do so.

A person should also note that a relapse may occur 6–18 months later, even if the treatment seemed effective.

A person should consult a doctor if they notice lesions developing after sexual activity, particularly if the wound ulcerates. It is also advisable for an individual to contact a doctor if they discover that a sexual partner has received a donovanosis diagnosis or if they suspect that they may have acquired the infection.

Donovanosis is treatable with antibiotics, and getting treatment as soon as possible can help prevent complications.

Donovanosis refers to a bacterial infection. The bacterium K. granulomatis causes the condition, which results in ulcerative lesions appearing on the skin, typically around the genital region, as well as the anus, perineum, or mouth.

A person may acquire donovanosis through sexual contact or, rarely, skin-to-skin contact. Donovanosis is rare in the U.S. and commonly occurs in tropical and subtropical countries.

A person can attempt to reduce the transmission of donovanosis by using barrier methods of protection during sexual activity. The symptoms take an average of 50 days to appear and typically include ulcerative lesions that may be beefy red and painless.

A doctor will typically require a skin sample to diagnose donovanosis correctly. A person should contact a doctor if they notice symptoms of donovanosis or are aware that a sexual partner has the condition. The infection is treatable with antibiotics such as azithromycin, doxycycline, and erythromycin.