What is donovanosis?

What is Donovanosis?

Donovanosis (also called granuloma inguinale) is a chronic, progressive, sexually transmitted bacterial infection caused by Klebsiella granulomatis (formerly Calymmatobacterium granulomatis) that presents with painless, highly vascular genital ulcers with a characteristic "beefy red" appearance that bleed easily on contact. 1, 2

Geographic Distribution and Epidemiology

• Donovanosis is endemic in tropical and developing regions, including India, Papua New Guinea, central Australia, and southern Africa 1, 2
• The disease is uncommon in developed countries but can occur in non-endemic areas through sexual transmission 3
• It predominantly affects adults, though rare cases in children have been reported through vertical transmission during vaginal delivery 4

Clinical Presentation

The hallmark features include:

• Progressive, painless ulcerative lesions without regional lymphadenopathy 1
• "Beefy red appearance" of lesions that are highly vascular and bleed easily on contact 1, 2
• Primary involvement of genital skin and mucosa, though extragenital manifestations can occur 5, 6
• Lesions can extend locally and cause significant tissue destruction if untreated 5

Causative Organism

• The causative organism is Klebsiella granulomatis (proposed reclassification from Calymmatobacterium granulomatis) 1, 3
• This organism cannot be cultured on standard microbiologic media, making diagnosis dependent on microscopic visualization 1, 5

Diagnostic Approach

Diagnosis requires microscopic visualization of Donovan bodies in tissue specimens:

• Donovan bodies appear as dark-staining intracytoplasmic inclusions within histiocytes 1, 2
• Specimens should be stained with Wright or Giemsa stain (or Whartin-Starry stain) 1, 3
• Tissue can be obtained via crush preparation or biopsy from the advancing edge of the lesion 1
• Samples should be taken from the lesion base where bacterial load is highest, avoiding necrotic areas 1

Important Clinical Pitfalls

• Secondary bacterial infection may develop in lesions, potentially obscuring the diagnosis 1, 2
• Lesions may be coinfected with other sexually transmitted pathogens, requiring comprehensive STI screening 1, 2
• False negatives occur if samples are taken from necrotic areas 1
• The disease can facilitate HIV transmission due to genital ulceration 7

Complications

• Untreated donovanosis can lead to massive tissue destruction, elephantiasis, strictures, and pelvic abscess 5
• Disseminated disease with osteomyelitis and septic arthritis has been reported 6
• Rare cases of malignant transformation to squamous cell carcinoma have been documented 7
• Extragenital manifestations including mastoiditis and temporal lobe abscess can occur, particularly in neonates 4

Treatment Overview

First-line treatment consists of:

• Trimethoprim-sulfamethoxazole (one double-strength tablet orally twice daily) for at least 3 weeks 2
• OR doxycycline (100 mg orally twice daily) for at least 3 weeks 2
• Therapy must continue until all lesions have completely healed, not just for the minimum duration 2
• Gentamicin (1 mg/kg IV every 8 hours) should be added if lesions do not respond within the first few days 2