Granuloma Inguinale/Donovanosis

Clinical Presentation

Granuloma inguinale is a chronic, relapsing, granulomatous anogenital infection caused by the bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis), which is endemic in tropical and developing areas, including India, Guyana, New Guinea, central Australia, and southern Africa. Symptoms usually occur 1-12 weeks after infection. The infection begins with the appearance of relatively painless nodules that break down into shallow, sharply demarcated ulcers with a beefy-red friable base of granulation tissue. The lesions may occur on the skin, genitalia, or perineal areas, and slowly spread to the lower abdomen and thighs. The lesions may develop secondary bacterial infection and can co-exist with other sexually transmitted infections.

Diagnostic Testing

Diagnosis requires visualization of Donovan bodies (numerous bacilli in the cytoplasm of macrophages demonstrated with Giemsa or Wright’s stain) in smears of scrapings from the ulcer base or histologic sections. Culture of C. granulomatis is difficult to perform and not routinely available.