Donovanosis

Overview – Donovanosis

Donovanosis is a chronic, sexually transmitted bacterial infection caused by Klebsiella granulomatis. It presents as painless, oozing genital ulcers with raised, red, granulation tissue. Although relatively rare, Donovanosis must be considered in cases of chronic genital ulcers—especially in endemic regions. Early diagnosis and treatment are vital to prevent disfigurement and misdiagnosis with other ulcerative sexually transmitted infections (STIs) like syphilis.

Definition

Donovanosis (also known as granuloma inguinale) is a chronic sexually transmitted infection caused by Klebsiella granulomatis, resulting in progressive ulcerative lesions of the genital and perineal areas.

Aetiology

• Causative agent: Klebsiella granulomatis (previously Calymmatobacterium granulomatis)
• Gram-negative intracellular bacterium
• Endemic in tropical and subtropical areas

Morphology / Pathophysiology

Pathogenesis

• Transmitted via direct contact with open genital ulcers during sexual activity
• No associated lymphadenopathy (important distinguishing feature from syphilis)

Morphological Features

Macroscopic

• Painless, red, oozing ulcers
• Characteristic rolled edges of granulation tissue
• Can affect the penis, labia, or perineum

Microscopic

• Donovan bodies: Oval, rod-shaped intracellular organisms seen within macrophages on microscopy

Clinical Features

• Painless genital ulcers: Chronic, oozing, and foul-smelling
• No regional lymphadenopathy
• May result in genital disfigurement if left untreated
• Differential considerations include syphilis (dry, painless ulcers + lymphadenopathy)

Investigations

• Clinical examination and detailed sexual history
• Microscopy from lesion scrapings to identify Donovan bodies
• PCR testing from lesion swabs
• Exclude syphilis using RPR (Rapid Plasma Reagin), VDRL (Venereal Disease Research Laboratory test), and TPHA (Treponema pallidum haemagglutination assay)

Management

• Antibiotic therapy:
  • Doxycycline
  • Azithromycin
  • Erythromycin
• Treatment is prolonged in chronic or extensive cases
• Monitor for healing and resolution of lesions

Complications

• Genital disfigurement due to chronic ulceration and scarring
• Secondary bacterial infection in chronic cases

Summary – Donovanosis

Donovanosis is a chronic ulcerative sexually transmitted infection caused by Klebsiella granulomatis, characterised by painless, oozing genital ulcers with rolled edges and no lymphadenopathy. Early recognition and antibiotic therapy are essential to prevent genital disfigurement. For more infectious genital ulcer conditions, visit our Reproductive Health Overview page.