How Does One Get Donovanosis & How is it Treated?

Donovanosis is an infection caused by Klebsella granulomatis.⁽¹⁾ The name of the infection is derived from Donovan bodies present in the people with this infection and is seen in the scrapings taken from the ulcerative lesions. It affects the genital region leading to painless ulcers that bleed easily.

Donovanosis infection is acquired through sexual contact, which involves directly coming in contact with the infected region. Donovanosis infection appears as cracks on the skin that do not heal naturally. It is therefore also known as flesh-eating infection. The hallmark of donovanosis is an ulcerative lesion in the genital region known as the perineum.

Donovanosis is a sexually acquired infection that spreads through sexual contact that includes vaginal, anal, and in rare cases oral sex.⁽²⁾ It can also spread to the newborn during the time of childbirth due to the bacteria present in the genital tract. However, it is rare. In a few cases, donovanosis may also get transmitted through skin-to-skin contact. The majority of donovanosis cases occur in people aged 20-40 years. ⁽³⁾

Donovanosis is rare in the United States where there are 100 cases of donovanosis each year. The condition is more prevalent in the tropical and subtropical regions, which include:

• The Caribbean
• South America
• Guyana
• Remote Northern Australian regions

According to Public Health England, 30 cases were reported of donovanosis in 2019.⁽⁴⁾

There are certain risk factors that increase the likelihood of acquiring this infection. These include:

• Having multiple sexual partners
• Being of age 20-40 years
• Undergoing tests for sexually transmitted diseases too infrequently
• Having sex without barrier contraceptive measures
• Poor hygiene and low socioeconomic status

The symptoms start occurring 1-12 weeks post-infection.⁽¹⁾ Sources suggest they may take 50 days to become apparent and the time period may vary from a few days to up to a year.

Slowly growing lesions are the most common symptom of donovanosis. They may appear as small papules or nodules on the skin that may ulcerate to resemble sores. These lesions are present in the genitals and may appear around the anus, perineum, or mouth.

The painless ulcers may appear beefy red and may bleed and the borders can also have a snake-like appearance.⁽²⁾

The lesions of donovanosis are of four types:

1. Ulcerogranulomatous or Ulcero-Vegetative Lesions: These are the most common types and have a beefy, red, non-tender appearance and bleed easily.
2. Hypertrophic or Verrucous Lesion: These lesions have irregular raised edges and a dry texture.
3. Necrotic Lesion: These lesions have a foul smell and are deep and cause tissue destruction.
4. Sclerotic or Cicatricial Lesions: These are the lesions that contain extensive plaques of scar tissue.

Some sources also divide these lesions into two types:

• Nodular Lesions: These are the lesions that are less common than the ulcero-vegetative type of lesions and consist of papules and nodules that are soft and red. They may also have some granulation.
• Elephantiasis Manifestations: These lesions primarily affect females and may involve the formation of scar tissue.

Scraping from the lesions is taken to view under a microscope. The presence of Donovan bodies help in diagnosing the condition. They appear as dark-staining cells on a tissue crush preparation or biopsy.

Also, molecular assays are used to identify causative agents.

The causative agent of donovanosis is K. granulomatosis and can be treated with antibiotics.

According to the Center for Disease Control and Prevention, azithromycin is recommended at a dose of 1 gram per week. These medications can be taken for more than 3 weeks. Other medications include:

• Doxycycline
• Erythromycin
• Bactrim

Additional antibiotics are prescribed if no treatment is seen. The person is advised to stop all sexual contact if diagnosed with donovanosis. Sexual intercourse can be resumed once the treatment is complete and the doctor tells it is safe to go ahead.

A relapse if donovanosis can occur in 6-18 months, even if the treatment is effective.

A doctor should be contacted if lesions are noticed after sexual activity, especially if the wound ulcerates. Getting treated at the earliest can be helpful in preventing complications.