What Is Granuloma Inguinale (Donovanosis)?

Medically Reviewed by Melinda Ratini, MS, DO on March 01, 2024
3 min read

Granuloma Inguinale (Donovanosis) is a bacterial infection that causes sores on the genitals. It’s known as an STI, or sexually transmitted infection, because it spreads mainly through sexual contact. It’s rare in the U.S. but more common in tropical and subtropical climates like India, South Africa, Southeast Asia, and South America. Though formerly more common in Australia, doctors managed to bring case numbers way down through careful, prompt treatment.

The most common symptom is slow-growing open lesions, or “ulcers,” directly on the genitals in both men and women. About 1 in 10 people may also have ulcers in the area around the genitals or the anus, and even the mouth.

Though typically painless at first, these sores often bleed easily and can worsen without prompt treatment. They usually start as firm, raised bumps (sometimes called nodular lesions) before they split into open lesions.

Donovanosis has four main types, defined by the appearance of these sores:

  • Ulcerogranulomatous. This is most common, especially at first. They’re beefy-red in appearance with tissue that gets “grainier” (granulation) and highly vascular (lots of tiny blood vessels) over time. They typically don’t hurt, but they tend to bleed easily.
  • Hypertrophic. These are sometimes called “verrucous” or “cicatricial” ulcers. They have an uneven border and are typically completely dry.
  • Necrotic ulcers grow deeper into the skin. They can be foul-smelling and often painful to the touch.
  • Fibrous ulcers look like painless scar tissue.

The bacteria Klebsiella granulomatis infects the genital area to cause donovanosis. This happens most often through sexual contact, but it may also happen in very rare cases through nonsexual skin-to-skin contact.

Symptoms typically show up about 1 to 4 weeks after infection, but in some cases, it can take as long as a year.

The first sign is a nodule, sore, or open lesion in the genital area. But there are a few things that can cause sores like this. That’s why the only way to know for sure if you have donovanosis is to consult your doctor.

They will do a full physical exam. If they suspect donovanosis, they’ll take samples from the ulcer to test for the bacteria (Klebsiella granulomatis) that causes it. They may also take a blood sample to test for and rule out other possible STIs.

Your doctor will likely prescribe antibiotics (specifically azithromycin) to treat donovanosis. The antibiotics stop bacteria growth. As a result, ulcers typically start to heal within days.

But if the infection has been around for a while, you may need antibiotics for several weeks.

In serious cases, or where ulcers get infected with a second bacteria, you may need prescription pain medications and more antibiotics. It’s important to finish the cycle of antibiotics that your doctor prescribes to make sure that the sores heal completely.

Keep in mind that because donovanosis ulcers often bleed easily, they raise your risk for getting or giving HIV, which can cause serious illness.

Even after an apparently successful cycle with antibiotics, donovanosis sometimes returns (called a relapse) 6 to 18 months afterward and may need more treatment.

Left untreated, donovanosis ulcers can keep growing and, over time, could damage or destroy larger areas of skin. This can cause scar tissue and block nearby lymph vessels, leading to more health problems.

A long-term infection may also be linked to cancer of the genitals. If your doctor is concerned, they may suggest surgery to remove these ulcers.

In very rare cases, donovanosis can spread into other parts of your body, like your bones or liver. This could cause joint pain and swelling, fever, night sweats, weight loss, and a general feeling of illness.

The best way to avoid getting donovanosis or giving it to someone else is to monitor your own sexual health and that of your sexual partner. Avoid sex with anyone who has visible genital sores, and use a condom with any partner if you’re unsure of their sexual health and history.