Granuloma Inguinale (Donovanosis)

What is granuloma inguinale?

Granuloma inguinale (donovanosis) is a bacterial infection of your genitals. It’s a type of sexually transmitted infection (STI). In rare cases, someone can contract granuloma inguinale through nonsexual contact.

Donovanosis causes sores on your genitals. Without treatment, this condition worsens over time. It can lead to scarring of your genitals, chronic inflammation and, sometimes, cancer. Antibiotics usually successfully treat granuloma inguinale.

Who might have granuloma inguinale?

Most people who have granuloma inguinale are sexually active adults between the ages of 20 and 40. But there have been several cases in newborns and infants. These cases may come from nonsexual contact with infected adults or an infected mother giving birth.

How common is granuloma inguinale?

People in the U.S. rarely get granuloma inguinale. But this condition still occurs in tropical and subtropical countries, including:

• Argentina.
• Brazil.
• The Caribbean.
• French Guiana.
• India.
• Indonesia.
• Papua New Guinea.
• South Africa.

Donovanosis used to be common in Australia, but numbers have decreased in recent years.

What causes granuloma inguinale?

Bacteria called Klebsiella granulomatis causes granuloma inguinale. Anyone who has vaginal or anal sex with a partner with granuloma inguinale can pass on these bacteria.

In rare cases, you can also pass on these bacteria through:

• Oral sex.
• Skin-to-skin contact without sex.

What are the symptoms of granuloma inguinale?

Symptoms of granuloma inguinale usually show up from one to 12 weeks after infection. Sometimes, symptoms won’t appear for up to a year.

The first symptom of granuloma inguinale is a painless red bump (lesion or ulcer) on or close to your genitals. This bump may bleed easily.

The bump slowly grows into a round red lump with irregular edges. The lump then breaks down into a sore that has a bad smell and may be painful.

Men and people assigned male at birth usually have these sores on their groin, thigh and external parts of the male reproductive system, including the:

• Penis.
• Scrotum.

Women and people assigned female at birth usually have these sores on parts of the female reproductive system, including the:

• Vagina.
• Vulva.

You might also find sores on your anus and buttocks if STI transmission happens during anal intercourse. They can sometimes show up around your mouth if you engaged in oral sex with a person who was infected.

These sores keep growing and can spread to nearby tissue. Sores also continue to spread without treatment.

How is granuloma inguinale diagnosed?

A healthcare provider will ask about your medical history and symptoms. They’ll do a physical exam to look for sores on and around your genital areas.

If your provider suspects donovanosis, they’ll ask if you’ve:

• Had contact with someone from a region where granuloma inguinale occurs.
• Visited a region where this condition occurs.

To help diagnose donovanosis, your provider may:

• Scrape a sore to take a sample of fluid. They’ll examine the sample under a microscope.
• Confirm the diagnosis by taking a sample of tissue (biopsy) using forceps or a scalpel. They’ll look at this tissue under a microscope.
• Take a sample of blood to rule out other STIs.

How is granuloma inguinale treated?

Your provider will treat granuloma inguinale with antibiotics. You usually take these antibiotics for at least three weeks. It’s important to finish all of your medication for it to work. Your provider may also give you an antibiotic injection, either in your muscle or through a vein.

Though antibiotics usually successfully treat granuloma inguinale, you may also need surgery if you have extensive damage to your tissues.

Are there complications if you don’t treat granuloma inguinale?

If you have untreated granuloma inguinale, the infection may spread to your:

• Bones.
• Joints.
• Liver.

Other complications of untreated donovanosis may include:

• Cancer of your genitals, such as penile cancer, vulvar cancer or vaginal cancer.
• Narrowing (stenosis) of your anus, urethra or vagina.
• Osteomyelitis, when you have a painful bone infection.
• Polyarthritis, when arthritis affects five or more joints.
• Pseudo-elephantiasis, when your genitals massively enlarge.
• Spread of infection into your abdominal cavity.
• Vaginal bleeding.

How can I reduce my risk of granuloma inguinale?

You can reduce your risk of donovanosis by:

• Avoiding unprotected sex and multiple partners.
• Making sure you get diagnosed and treated quickly for any STIs to stop the spread to others.
• Using barrier protection like condoms or dental dams during any kind of sexual intercourse.

What can I expect if I have granuloma inguinale?

Treated granuloma inguinale can start healing within seven days. But sores may heal more slowly and leave scars.

What is the outlook if I have granuloma inguinale?

Treatment with antibiotics usually successfully stops granuloma inguinale. But sometimes, sores can come back even with treatment.

Donovanosis can return six to 18 months after you complete antibiotics. Even if your treatment seems successful, you should continue to see your provider regularly for checkups.

How do I take care of myself with granuloma inguinale?

If a provider diagnoses you with donovanosis, let your current sex partners know. If you’ve had any sexual contact within 60 days of your symptoms appearing, your partners need to see a provider for examination and treatment.

You should stop any sexual activity until you complete treatment and your sores heal fully. Your provider may also test you for HIV, as sores that bleed increase your risk.

When should I see my healthcare provider?

See a healthcare provider if you:

• Notice red bumps or sores coming back.
• See bumps or sores spreading to other parts of your body.

Granuloma inguinale may spread to your abdomen, bones or liver. See your provider if you experience any of these symptoms after treatment:

• Anemia.
• Chills.
• Delirium.
• Fast heart rate (tachycardia).
• Fatigue.
• Fever.
• Night sweats.
• Shortness of breath (dyspnea).
• Unexplained weight loss.

A note from Cleveland Clinic

Granuloma inguinale (donovanosis) is a sexually transmitted infection (STI) caused by a bacterial infection of your genitals. In rare cases, a person can also contract it through skin-to-skin contact. Granuloma inguinale is rare in the U.S. but is still found in tropical and subtropical countries. Symptoms generally appear from one to 12 weeks after infection, though some may not show up for a year.

Donovanosis usually starts with a painless red bump on your genitals that becomes a sore. These sores can spread without treatment. Providers use antibiotics to treat granuloma inguinale. Symptoms may return six to 18 months after treatment, so providers recommend regular checkups. See a healthcare provider if you develop symptoms or sores on or near your genitals.