Granuloma inguinale (donovanosis)
Donovanosis is treated through the use of antibiotics, such as azithromycin, which is administered orally until the lesions have completely healed.

The recommended treatment of donovanosis involves the use of the antibiotic azithromycin, which is administered orally in a dose of one gram weekly or 500 mg daily. The treatment must be continued for a long duration (more than three weeks) to ensure proper healing.

Certain alternative regimens are sometimes recommended, which include:

  • Doxycycline 100 mg administered orally two times a day for at least three weeks and until all lesions have completely healed
  • Erythromycin base 500 mg administered orally four times a day for over three weeks and until all lesions have completely healed
  • Trimethoprim-sulfamethoxazole one double-strength (160/800 mg) tablet administered orally two times a day over three weeks and until all lesions have completely healed

The doctor may add other antibiotics (combination therapy) to any of these regimens if no improvement is seen within a few days of starting the treatment.

Relapses have been reported about 6 to 18 months after effective therapy. Hence, regular follow-up is needed until all the signs and symptoms of donovanosis go away.

What are the complications of donovanosis?

Early treatment of donovanosis is necessary to prevent tissue damage. Untreated cases may result in genital tissue damage, leading to scarring, discoloration of the genitals, and permanent genital swelling (lymphedema). Chronic scars or lesions may develop into cancer (squamous or basal cell carcinoma).

Donovanosis increases the risk of other sexually transmitted infections including human immunodeficiency virus (HIV).

  • Donovanosis and HIV coinfection can result in more severe and persistent lesions. 
  • There have been reports of autoamputation of the penis of a man infected with donovanosis and HIV.

What is donovanosis?

Donovanosis or granuloma inguinale is a chronic sexually transmitted infection caused by the bacteria Klebsiella granulomatis (previously called Calymmatobacterium granulomatis). 

  • The disease is quite rare in the U.S. with only about 1,000 cases reported per year.
  • Most infections occur in people who have traveled to the places where this infection is common, such as tropical and subtropical areas (southeast Asia, the Caribbean, Guyana, and New Guinea).

The disease mainly spreads through vaginal and anal intercourse and rarely through oral sex. It affects both males and females and is most commonly seen in people aged 20 to 40 years olds.

Donovanosis may be transmitted from mother to child during the passage of the baby through an infected birth canal.

What are the symptoms of donovanosis?

The signs and symptoms of donovanosis may occur as early as a day to as late as a year after the infection and may include:

  • Anal sores (seen in about 50 percent of the affected individuals)
  • Bumps (itchy and red) in the anal and genital area
  • Ulcerations in the genital and anal areas (painless, beefy-red ulcers that tend to bleed easily)
  • Genital swelling
  • Change in the color of the genitals and the surrounding skin
  • Knife cut-like appearance of the skin folds

The lesions keep progressing with time to damage the genital tissues. There could be narrowing or stricture formation of the genital and urinary passages. The lesions often grow to form masses that may resemble genital warts.

The long-term infection leads to permanent swelling or elephantiasis of the genitals that is more commonly seen in females than in males.

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Medically Reviewed on 11/9/2021
References
Image Source: iStock Images

Centers for Disease Control and Prevention. Granuloma Inguinale (Donovanosis). https://www.cdc.gov/std/treatment-guidelines/donovanosis.htm

Satter EK. Granuloma Inguinale (Donovanosis). Medscape. https://emedicine.medscape.com/article/1052617-overview

Ngan V. Granuloma inguinale. DermNet New Zealand. https://dermnetnz.org/topics/granuloma-inguinale