Donovanosis

Donovanosis is a rare disease that usually only infects people who live in tropical and subtropical regions where there is limited access to healthcare. Most cases are reported in South Africa, Papua New Guinea, and in some parts of South America and India.

Donovanosis is an endemic disease which means it tends to stay local, but it can also strike people who have traveled to the region.

Usually considered a sexually transmitted disease, some cases of donovanosis have also spread through non-sexual skin-to-skin contact. Donovanosis causes ulcers in the genital region, which is why it must be considered as a potential diagnosis for people who have traveled to high-risk places. If left untreated, donovanosis can lead to serious complications. 1 2

Donovanosis, also known as granuloma inguinale, is a condition primarily transmitted through sexual contact, which is why it’s considered an STD (sexually transmitted disease). Besides sexual contact, it can also spread from one person to another through casual skin-to-skin contact. A mother may also transmit donovanosis to her child when giving birth.

This condition is caused by a bacteria called klebsiella granulomatis. Donovanosis is rare, but it still has to be considered for people living in, or returning from, tropical and subtropical areas such as India, Papua New Guinea, South Africa and certain parts of South America.

Donovanosis is an STD that can occur at the same time as other bacterial infections or other STDs such as syphilis, HIV, chlamydia, trichomonas and gonorrhea. 1 2

Donovanosis symptoms usually present as a painless, red lump on the skin of the genital area. This lump grows larger, breaks down and forms an ulcer. This ulcer begins to spread and causes multiple ulcers in the region, especially on the vulva, the penis, or around the anus.

These genital ulcers are usually painless and can bleed easily. This is because the lesions are highly vascular, which means they are full of blood vessels, giving them a beefy red appearance. The ulcers mostly occur on the genitals, the perineum, or the anal region, but the bacteria can also spread to the organs which can be life-threatening.

In very rare cases, the infection can also affect the bones.Donovanosis lesions can also be proliferative, meaning that the cells in the lesions have the ability to duplicate, causing the lesion to grow bigger. A donovanosis ulcer can also cause a foul smell when there’s another bacterial infection present at the same time.

Donovanosis is a chronic and progressive condition that can cause permanent damage to tissues, especially if left untreated. However, it’s not a flesh-eating STD as claimed by some. The ulcers can grow very deep, leaving no other option but to surgically remove them, which has led to the false impression that the bacteria is flesh-eating. 1 2

When donovanosis doesn’t get treated, various complications may occur. The bacteria may travel through the blood and reach the bones or organs. When the bacteria spreads, this can often be to the uterus and other nearby organs.

Untreated donovanosis may also cause damage to the lymphatic system. This system supports various crucial processes in the body such as the fluid balance and the immune system. As donovanosis causes damage to this system, there may be a fluid build up, which may cause swelling of the genitalia. 3

People with donovanosis also tend to have a higher risk of contracting HIV. Untreated ulcers also have a high possibility of evolving into carcinogenic lesions, so it’s important to treat donovanosis as soon as possible. 2

Donovanosis can be prevented by practising safe sex with the correct use of a condom. The condition is transmitted through contact with sores, so it’s important to be aware and have frank conversations with sexual partners.

Scientists are still unsure about the incubation period of donovanosis. Some people have an incubation period of 1 to 4 weeks, while in others it can take up to a year after exposure for the condition to present itself. People are most infectious when the ulcers are actively present. 4 5

Donovanosis is curable, but early diagnosis is necessary to avoid severe complications. The doctor will first ask you questions about your symptoms and your sexual history.During a physical exam, the doctor will look for the ulcerative lesions that donovanosis causes. As there are various conditions that can cause genital ulcers in both men and women, such as cancer, herpes simplex and syphilis, more tests will be necessary to come to a final diagnosis.

The doctor may sample tissue from the lesion and place it under a microscope. This is called a biopsy and will help determine if there’s an infection or a malignancy. If there’s an infection, the biopsy will also help determine which bacteria or virus is causing it.

Biopsy samples from people who have donovanosis will show a specific organism called donovan bodies, which confirms the diagnosis of donovanosis. 5 6 7

Donovanosis treatment will see the person having to take antibiotics until all ulcers are healed. It’s important to completely finish the course of antibiotics, as the bacteria can still be present when you’re already feeling better. Finishing the course makes sure that all bacteria have been killed so that the infection is appropriately dealt with.It’s important to know that a donovanosis infection can reoccur 6-18 months after treatment. That’s why follow-up is important and why retreatment might be necessary if the infection comes back. The sores will slowly heal with treatment, but they can leave scars. 1

Besides treatment with antibiotics, it’s important to thoroughly wash everything that has been in contact with the ulcers such as underwear and bed sheets. It’s also important to notify any sexual partners you have been in contact with for the last 60 days.

In cases where treatment wasn’t started early enough, it’s possible that surgery is necessary to remove the ulcers. Ulcers that remain on the body may evolve into cancer, so it’s crucial that these are treated appropriately.

As donovanosis often occurs in combination with other STDs, your doctor will also check for other sexually transmitted diseases, as these can often be present without any clear symptoms. This screening is important, as untreated STDs can have serious complications such as infertility, cancer and even death. 4 8

Q: What is granuloma inguinale?

A: Granuloma inguinale is a synonym for donovanosis. Granuloma refers to a mass of inflamed tissue, whereas inguinale refers to the groin area.

Q: How do you get donovanosis?

A: Donovanosis is spread by being in contact with an infected person. Usually, this contact is sexual, although donovanosis can also be spread through casual skin-to-skin contact.

Q: How common is donovanosis?

A: Donovanosis is a very rare disease due to successful bacteria eradication programs. Most cases are reported by people living in tropical or subtropical regions, or by people that have traveled there.

Q: Do donovanosis tests exist?

A: The best way to confirm an infection with the bacteria that causes donovanosis is by means of a biopsy.