Donovanosis (Granuloma Inguinale)

Donovanosis usually starts as one or more small, painless lumps on the genitals or around the anus. These gradually develop into beefy-red, velvety ulcers that bleed easily when touched.

Without treatment, the sores can enlarge and spread, causing damage to the surrounding tissue. Some people may also notice swelling in the groin.

Because these symptoms can resemble other conditions, such as syphilis or genital herpes, any new or unusual genital sores should be assessed by a healthcare professional.

Yes. During the incubation period, donovanosis may not cause any noticeable symptoms.

Symptoms usually appear within one to twelve weeks after exposure, but in some cases they may take several months or up to a year to develop. The first signs are typically painless, so they can be easy to overlook.

If you have concerns after a potential exposure or notice any unusual genital sores or lumps, seek medical advice for assessment and testing.

Without treatment, donovanosis can cause progressive damage to the skin and soft tissues of the genital or anal area.

Possible complications include:

• Extensive scarring and tissue destruction
• Narrowing of the urethra, vagina, or anus
• Chronic genital swelling (genital elephantiasis)
• Secondary bacterial infections
• An increased risk of acquiring or transmitting HIV
• Rarely, skin cancer developing in long-standing affected tissue

Early treatment with antibiotics can prevent most of these complications.

Symptoms usually develop between one and twelve weeks after exposure, although they can take several months or, rarely, up to a year to appear.

The first signs are typically small, painless red lumps or sores around the genitals or anus that gradually enlarge. If you notice any unusual sores or have recently traveled to an area where donovanosis is more common, seek medical assessment.

Donovanosis is caused by the bacterium Klebsiella granulomatis. It is primarily spread through direct sexual contact with infected lesions.

Although rare in the UK, it is more common in tropical and subtropical regions. If left untreated, it can cause slow-growing genital or anal ulcers that may lead to scarring.

Donovanosis is uncommon in the UK, but the risk is higher if you have unprotected sex with someone who has the infection or who has recently been in a region where it is more common.

Risk factors include:

• Unprotected vaginal, anal, or oral sex
• Sexual contact in or with partners from tropical or subtropical regions
• Having multiple sexual partners

Using condoms and seeking medical advice for any unusual genital sores can help reduce the risk of infection.

The best way to reduce your risk of donovanosis is to practise safer sex by using condoms during vaginal, anal, and oral sex.

You can also lower your risk by limiting your number of sexual partners, discussing sexual health with partners, and avoiding sexual contact if either person has unexplained genital sores or ulcers. Regular sexual health check-ups are recommended if you are at increased risk.

Yes. Condoms significantly reduce the risk of donovanosis but cannot provide complete protection.

The infection spreads through direct contact with sores, so transmission is still possible if affected skin is outside the area covered by the condom.

No. Donovanosis is not considered to be spread through casual or social kissing.

It is primarily transmitted through direct skin-to-skin contact during vaginal, anal, or oral sex with an infected person.

No. Donovanosis is not usually spread through towels, clothing, or other personal items.

The bacteria do not survive well outside the body, and transmission almost always occurs through direct sexual contact with an infected sore or lesion.

No, blood-borne transmission extremely unlikely.

The bacteria, Klebsiella granulomatis, causes a local infection of the skin and mucous membranes and is not known to be transmitted through donated.

Donovanosis is diagnosed through a physical examination and laboratory testing. A healthcare professional will assess any genital or anal sores and take a tissue scrape or small sample from an ulcer.

The sample is examined for characteristic bacteria, and a PCR test may be used in some cases. Testing for other sexually transmitted infections is often recommended because symptoms can be similar.

The most common test is a tissue scrape or biopsy from an active ulcer, which is examined under a microscope for characteristic Donovan bodies.

A PCR test may also be used to detect the DNA of Klebsiella granulomatis. Additional STI tests are often performed to rule out other causes of genital ulcers.

A correct diagnosis is based on your symptoms, physical examination, travel history, and laboratory testing.

Healthcare professionals will look for painless, beefy-red ulcers and confirm the diagnosis with a tissue sample or PCR test. Testing for other conditions, such as syphilis and herpes, may also be needed.

Yes. Donovanosis can resemble other conditions that cause genital sores, including syphilis, genital herpes, chancroid, lymphogranuloma venereum, and some inflammatory skin conditions or skin cancers.

Laboratory testing is needed to confirm the diagnosis and ensure appropriate treatment.

If a tissue scrape is inconclusive, a skin biopsy may be performed to examine the affected tissue in more detail.

PCR testing can also detect the DNA of Klebsiella granulomatis. Routine blood or urine tests do not diagnose donovanosis.

No. While the appearance of the sores may strongly suggest donovanosis, laboratory testing is needed to confirm the diagnosis.

A tissue scrape or biopsy helps distinguish donovanosis from other conditions with similar symptoms.

No. Donovanosis cannot be reliably diagnosed at home.

Its symptoms can resemble other infections and skin conditions, so a healthcare professional will need to examine the affected area and arrange laboratory testing. Home STI kits do not typically test for donovanosis.

The long-term outlook is generally excellent when donovanosis is diagnosed early and treated with the appropriate antibiotics.

Most people recover completely, although healing can take several weeks. Untreated infection can lead to scarring, permanent tissue damage, and chronic swelling, so follow-up is important to confirm the infection has cleared.

No. Having donovanosis does not provide lifelong immunity.

You can become infected again if you are exposed to Klebsiella granulomatis in the future. Practising safer sex and ensuring sexual partners are treated can help reduce the risk of reinfection.

Yes. Complete your full course of antibiotics and attend any recommended follow-up appointments to confirm the infection has cleared.

To reduce the risk of reinfection:

• Ensure recent sexual partners are assessed and treated where appropriate.
• Avoid sexual contact until treatment is complete and sores have healed
• Use condoms during vaginal, anal, and oral sex

Yes. Current and recent sexual partners should be informed so they can be assessed and treated if necessary.

Many sexual health services offer confidential partner notification, allowing partners to be informed anonymously without revealing your identity.

Yes. Avoid vaginal, anal, and oral sex, and avoid sharing or using sex toys, until you have completed treatment and all sores have fully healed.

Condoms can reduce the risk of transmission but may not provide complete protection if sores are located on uncovered skin. Informing recent sexual partners and ensuring they assessed and treated where appropriate also helps prevent the infection from spreading.

Transmission of donovanosis to a baby is possible but very rare. It is most likely to occur during vaginal delivery if the baby comes into direct contact with active genital lesions.

There is no evidence that donovanosis is routinely transmitted through the placenta during pregnancy. Prompt treatment reduces the risk of complications for both parent and baby.

Yes. During pregnancy, donovanosis lesions may enlarge or progress more rapidly due to hormonal and physical changes.

Potential complications include:

• Larger or more extensive genital ulcers
• Rare transmission to the baby during vaginal birth
• Increased risk of bleeding or delivery complications if lesions are extensive

Early diagnosis and treatment help minimise these risks.

Donovanosis is extremely rare in the UK, making it uncommon during pregnancy.

Pregnancy does not increase the risk of infection, although existing lesions may become larger or spread more quickly. Any new genital sores or ulcers should be assessed promptly.

Yes. Donovanosis can be treated during pregnancy using antibiotics that are considered safe for both parent and baby.

Azithromycin is the preferred treatment in most cases, while antibiotics such as doxycycline are generally avoided during pregnancy. Treatment is usually continued until all lesions have completely healed, as prolonged treatment is often required for donovanosis.

The best way to reduce the risk of donovanosis during pregnancy is to practise safer sex and seek medical advice for any new genital sores or ulcers.

Additional precautions include:

• Using condoms during vaginal, anal, and oral sex
• Attending recommended sexual health check-ups if at increased risk
• Completing any prescribed treatment
• Ensuring sexual partners are assessed and treated where appropriate

Yes. Active donovanosis lesions around the genital area may slow postpartum healing or increase the risk of secondary infection.

The infection is not known to pass through breast milk. Antibiotics such as azithromycin are generally considered compatible with breastfeeding, although treatment should always be guided by a healthcare professional.