Granuloma inguinale

Granuloma Inguinale (Donovanosis)

Medical content reviewed and approved by Dr. GP Yadav, MD, Dermatology Specialist; STI/STD Expert

Definition

Granuloma inguinale, also known as donovanosis, is a slowly progressive bacterial sexually transmitted infection caused by Klebsiella granulomatis. It is characterized by painless, beefy-red ulcerative lesions in the genital region that bleed easily and can cause tissue destruction if untreated.

Symptoms of Granuloma Inguinale

Symptoms of granuloma inguinale typically develop slowly over weeks to months after exposure. The initial lesion is a painless papule or nodule that erodes to form a characteristic beefy-red, friable ulcer with rolled edges. The ulcers are highly vascular and bleed easily. Satellite lesions may develop and merge with the primary ulcer. Without treatment, the lesions progressively enlarge and cause significant tissue destruction. Lymphadenopathy is uncommon, but subcutaneous nodules (pseudobuboes) may develop in the inguinal region.

Common Symptoms:

Painless, beefy-red ulcerative lesions in genital region
Granulation tissue that bleeds easily on contact
Rolled, raised ulcer margins with surrounding edema
Satellite lesions that coalesce with primary ulcer
Extra-genital lesions (oral, nasal, cervical) in advanced cases

Clinical Images

Granuloma inguinale beefy-red ulcer on male genitalia showing characteristic friable granulation tissue caused by Klebsiella granulomatis infection — Granuloma inguinale (donovanosis) presenting as a beefy-red, friable ulcer on the male genitalia with characteristic granulation tissue that bleeds easily on contact.
Image provided by Dr. GP Yadav

Donovanosis ulcerative lesion with rolled raised edges and granulating base showing painless character typical of granuloma inguinale infection — Granuloma inguinale lesion demonstrating the characteristic rolled, raised ulcer margins with a beefy-red granulating base and surrounding tissue edema.
Image provided by Dr. GP Yadav

Advanced granuloma inguinale with extensive tissue destruction and scarring showing progressive ulcerative lesions in genital region — Advanced granuloma inguinale with extensive tissue destruction and fibrosis, demonstrating the progressive nature of untreated donovanosis with scarring and deformity.
Image provided by Dr. GP Yadav

Granuloma inguinale pseudobubo showing subcutaneous inguinal nodule with overlying skin changes in donorvanosis patient at STD Nepal — Granuloma inguinale with pseudobubo formation showing a subcutaneous nodule in the inguinal region with characteristic overlying skin changes and erythema.
Image provided by Dr. GP Yadav

Granuloma inguinale lesion on perineum showing extensive ulceration with granulation tissue and surrounding hyperpigmentation from chronic infection — Granuloma inguinale involving the perineum with extensive ulceration, exuberant granulation tissue, and surrounding hyperpigmentation from chronic inflammation.
Image provided by Dr. GP Yadav

Transmission of Granuloma Inguinale

Granuloma inguinale is primarily transmitted through sexual contact with active ulcerative lesions. The bacterium Klebsiella granulomatis enters through breaks in the skin or mucous membranes during sexual activity. It is considered a moderately contagious infection, with transmission requiring repeated or prolonged exposure. The infection is endemic in tropical and subtropical regions including parts of Africa, South America, India, and Papua New Guinea. Non-sexual transmission is rare but possible through direct contact with infected tissue.

Transmission Methods:

Unprotected vaginal intercourse
Unprotected anal intercourse
Direct skin-to-skin contact with infected lesions

Incubation Period

Typical period: 1-12 weeks

The incubation period for granuloma inguinale varies widely, ranging from 1-12 weeks with an average of approximately 50 days. The prolonged and variable incubation period makes contact tracing challenging. Lesions progress slowly, and early-stage infection may go unnoticed by the affected individual.

Complications of Granuloma Inguinale

Untreated granuloma inguinale can lead to extensive tissue destruction with fibrosis and scarring. Genital elephantiasis results from chronic lymphatic obstruction. Cicatrization can cause urethral, vaginal, or anal stenosis requiring surgical correction. Chronic inflammation may rarely lead to squamous cell carcinoma transformation. Secondary bacterial infections complicate the clinical course. The disease does not resolve spontaneously and requires specific antibiotic therapy.

Possible Complications:

Progressive tissue destruction and mutilation
Genital elephantiasis due to lymphatic obstruction
Urethral, vaginal, or anal stenosis
Squamous cell carcinoma arising from chronic lesions
Secondary bacterial infection of ulcerated tissue

Treatment Options for Granuloma Inguinale

Treatment of granuloma inguinale requires prolonged antibiotic therapy, typically for 12 weeks or until all lesions have completely healed. Relapse can occur months to years after apparently successful treatment, so long-term follow-up is recommended. All sexual partners within the preceding 40 days should be examined and treated. Patients should be tested for HIV and other STIs. Surgical intervention may be required for complications such as stenosis or elephantiasis.

Azithromycin 1g weekly for 12 weeks

Azithromycin 1g orally once weekly for at least 12 weeks is the recommended first-line treatment. Continue until lesions have completely healed to prevent relapse.

Doxycycline 100mg twice daily for 12 weeks

Doxycycline 100mg orally twice daily for at least 12 weeks is an effective alternative regimen. Contraindicated in pregnant women and children under 8 years.

Ciprofloxacin 750mg twice daily for 12 weeks

Ciprofloxacin 750mg orally twice daily for at least 12 weeks is an alternative for patients unable to tolerate first-line options.

Prevention of Granuloma Inguinale

Prevention relies on standard STI prevention measures including condom use and partner notification. Early diagnosis and treatment of cases prevents further transmission. There is no vaccine available. Public health measures include surveillance in endemic areas, health education about recognizing genital ulcers, and accessible STI diagnostic services. Individuals with active lesions should abstain from sexual activity until treatment is complete and lesions have fully healed.

Prevention Measures:

Consistent and correct use of condoms
Early diagnosis and treatment of index cases
Partner tracing and treatment
Avoiding sexual contact with active genital ulcers
Improved genital hygiene practices

Important Disclaimer

⚠️This information is for educational purposes only and should not be used for self-diagnosis.
⚠️For accurate diagnosis and treatment, please consult with a qualified healthcare professional at an accredited medical facility.
⚠️Medical procedures and treatments should only be administered by licensed healthcare providers.
⚠️If you suspect you have an STI, visit STD Nepal clinic for confidential testing and treatment.

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