Donovanosis: Symptoms, Causes, and Effective Treatments Explained

Introduction

Donovanosis, also known as granuloma inguinale, is a rare sexually transmitted infection (STI) caused by the bacterium Klebsiella granulomatis. First identified in the early 20th century, Donovanosis is most prevalent in tropical and subtropical regions, including parts of India, Papua New Guinea, southern Africa, and the Caribbean. Although uncommon in the United States and Europe, cases can still occur, particularly among individuals who have traveled to areas where the infection is more widespread.

This article provides a comprehensive overview of Donovanosis, covering its risk factors, symptoms, diagnostic tests, treatment options, and home care strategies. By understanding the condition and its progression, patients can seek timely medical care and manage their symptoms effectively.

What is Donovanosis?

Donovanosis is a sexually transmitted infection with specific risk factors, symptoms, diagnostic tests, medications, and procedures for treatment, along with home care strategies to alleviate symptoms.

Description of Donovanosis

Donovanosis is a chronic bacterial infection that primarily affects the skin and mucous membranes of the genital and anal regions. It is caused by Klebsiella granulomatis, which invades the skin and leads to the formation of painless, beefy-red ulcers. These ulcers can progressively enlarge if left untreated, and while they are not typically painful, they can cause significant tissue damage over time.

The progression of Donovanosis can be slow, with symptoms sometimes taking weeks or months to appear after exposure. If untreated, the infection can spread to nearby tissues and, in rare cases, to distant parts of the body, including the bones and liver. Although not highly contagious, Donovanosis is transmitted through direct contact with ulcers during sexual activity.

While Donovanosis is rare in many parts of the world, it remains a public health concern in certain regions. According to the World Health Organization (WHO), the prevalence of Donovanosis is highest in tropical and subtropical areas, with sporadic cases reported in other regions due to travel or migration. Early diagnosis and treatment are crucial to prevent complications and the spread of the infection.

Risk Factors for Developing Donovanosis

Lifestyle Risk Factors

Certain lifestyle factors increase the risk of contracting Donovanosis. The most significant risk factor is engaging in unprotected sexual activity, particularly with partners from regions where the infection is more common. Individuals with multiple sexual partners or those engaging in high-risk sexual behaviors are at a higher risk of contracting sexually transmitted infections (STIs), including Donovanosis.

Travel to or residence in areas where Donovanosis is endemic, such as parts of India, Papua New Guinea, and southern Africa, also increases the likelihood of exposure. Additionally, individuals without regular access to healthcare or STI screening may be at higher risk, as untreated infections can spread more easily within communities.

Medical Risk Factors

Medical conditions that compromise the immune system, such as HIV/AIDS, can increase the risk of developing Donovanosis. A weakened immune system may make it more difficult for the body to fight off infections, including bacterial infections like Donovanosis. People with other STIs, such as syphilis or herpes, may also be at higher risk, as the presence of open sores or ulcers can provide an entry point for Klebsiella granulomatis.

Additionally, individuals who have previously had Donovanosis may be at risk of reinfection if exposed to the bacteria again. While treatment can effectively clear the infection, it does not provide immunity, meaning reinfection is possible.

Genetic and Age-Related Risk Factors

There is no known genetic predisposition to Donovanosis, meaning it does not appear to run in families or be inherited. However, age can play a role in the risk of contracting the infection. Donovanosis is most commonly diagnosed in sexually active adults, particularly those between the ages of 20 and 40. This age group is more likely to engage in sexual activity and may be more likely to travel to areas where the infection is endemic.

While Donovanosis can affect individuals of any gender, some studies suggest that men may be slightly more likely to contract the infection than women. This may be due to differences in sexual behavior or other social factors, but more research is needed to fully understand this disparity.

Clinical Manifestations of Donovanosis

Ulcerative Lesions

Ulcerative lesions are the hallmark of Donovanosis, occurring in nearly 100% of cases. These lesions typically begin as small, painless nodules that gradually break down into ulcers. The ulcers are usually beefy-red in appearance with well-defined edges. Donovanosis causes these lesions by infecting the skin and mucous membranes, leading to tissue destruction. As Klebsiella granulomatis invades, it triggers an inflammatory response that results in the breakdown of skin tissue. These lesions can increase in size if left untreated and may spread to surrounding areas, including the genital, anal, and inguinal regions.

Pain

Pain is reported in approximately 50% of Donovanosis cases, particularly as the disease progresses. Early-stage lesions are often painless, but as the ulcers enlarge and become more invasive, they can cause significant discomfort. Pain is typically associated with secondary infections or when the ulcers become deep and involve underlying tissues. The pain may worsen with movement or contact, especially in areas like the genital or anal regions, where friction is common. In some cases, pain may also be exacerbated by the presence of granulation tissue or swelling.

Bleeding

Bleeding occurs in about 70% of patients with Donovanosis. The ulcerative lesions are highly vascular, meaning they contain many small blood vessels. As the bacteria destroy the surrounding tissue, these blood vessels can rupture, leading to bleeding. The bleeding is often painless but can be persistent and difficult to control. In severe cases, the bleeding may be significant enough to require medical intervention. Patients may notice blood on their clothing or during urination or defecation if the ulcers are located near the genital or anal regions.

Foul-Smelling Discharge

Foul-smelling discharge is present in approximately 40% of Donovanosis cases. This symptom is often a sign of secondary bacterial infection. As the ulcers become larger and more necrotic (dead tissue), they create an environment conducive to bacterial overgrowth. The discharge may be yellow, green, or brown and is typically accompanied by a strong, unpleasant odor. This symptom can be distressing for patients and may lead to social discomfort or embarrassment. Proper wound care and antibiotics are essential to manage this complication.

Swelling

Swelling, or edema, is seen in about 30% of Donovanosis patients. The swelling is usually localized to the area around the ulcerative lesions and is caused by the body’s inflammatory response to the infection. As the immune system attempts to fight off the bacteria, fluid accumulates in the surrounding tissues, leading to swelling. In some cases, the swelling can be severe enough to cause difficulty with movement or urination, especially if the genital or anal regions are affected. Swelling may also contribute to pain and discomfort.

Granulation Tissue

Granulation tissue is a common feature of Donovanosis, occurring in nearly 100% of cases. This tissue appears as red, velvety patches within the ulcerative lesions and is a sign of the body’s attempt to heal the damaged area. However, in Donovanosis, the granulation tissue is often excessive and abnormal, leading to further complications. The bacteria interfere with normal wound healing, causing the granulation tissue to become hypertrophic (overgrown). This can result in the formation of large, disfiguring masses that may require surgical intervention.

Lymphadenopathy

Lymphadenopathy, or swollen lymph nodes, is relatively uncommon in Donovanosis, occurring in less than 10% of cases. When it does occur, it is usually a sign that the infection has spread beyond the initial site of the ulcerative lesions. The lymph nodes, which are part of the body’s immune system, become enlarged as they attempt to filter out the bacteria. Swollen lymph nodes may be tender to the touch and can cause discomfort, especially in the groin area. In rare cases, the lymph nodes may become abscessed, requiring drainage.

Itching

Itching is reported in about 20% of Donovanosis cases, particularly in the early stages of the disease. The itching is usually mild and localized to the area around the ulcerative lesions. It is caused by the body’s inflammatory response to the infection, which can irritate the nerve endings in the skin. While itching is not a major symptom of Donovanosis, it can be bothersome for some patients and may lead to scratching, which can further damage the skin and increase the risk of secondary infection.

Crusting

Crusting occurs in approximately 15% of Donovanosis cases, usually in the later stages of the disease. As the ulcerative lesions begin to heal, they may form scabs or crusts over the surface. This is a natural part of the healing process, but in Donovanosis, the crusting may be excessive or abnormal due to the presence of granulation tissue. The crusts can be thick and difficult to remove, and they may trap bacteria underneath, leading to further infection. Proper wound care is essential to prevent complications associated with crusting.

Scarring

Scarring is a common outcome of Donovanosis, especially in untreated or severe cases. The ulcerative lesions can cause significant tissue damage, leading to the formation of scar tissue as the body attempts to heal. The scars may be thick, raised, and disfiguring, particularly if the granulation tissue was excessive. In some cases, the scarring can cause functional problems, such as narrowing of the genital or anal openings, which may require surgical correction. Early treatment is crucial to minimize the risk of scarring.

Treatment Options for Donovanosis

Medications for Donovanosis

Azithromycin

Definition: Azithromycin is a broad-spectrum antibiotic commonly used to treat bacterial infections, including sexually transmitted infections (STIs) like Donovanosis (also known as granuloma inguinale). It works by preventing bacterial growth.

How and When It’s Used: Azithromycin is often the first choice for treating Donovanosis due to its effectiveness and ease of administration. It is typically given as a single dose or over a few days, depending on the severity of the infection. This medication is particularly helpful for patients who may have difficulty adhering to longer treatment regimens.

Expected Outcomes: Most patients notice improvement within a few days of starting treatment, with ulcers beginning to heal and symptoms like pain and swelling subsiding. Full recovery may take several weeks, depending on the extent of the infection.

Doxycycline

Definition: Doxycycline is a tetracycline antibiotic that works by inhibiting bacterial protein synthesis, effectively stopping bacterial growth.

How and When It’s Used: Doxycycline is another first-line treatment for Donovanosis. It is typically prescribed as a twice-daily oral medication for at least three weeks or until all lesions have healed. It is often used when patients cannot tolerate other antibiotics, such as azithromycin.

Expected Outcomes: Patients should experience gradual improvement, with ulcers healing over several weeks. Complete recovery may take longer if the infection is severe or has been present for an extended period.

Ciprofloxacin

Definition: Ciprofloxacin is a fluoroquinolone antibiotic that inhibits bacterial DNA replication, effectively killing the bacteria.

How and When It’s Used: Ciprofloxacin is typically used as a second-line treatment for Donovanosis, especially when first-line antibiotics like azithromycin or doxycycline are ineffective or not well-tolerated. It is usually taken twice daily for at least three weeks or until the lesions have fully healed.

Expected Outcomes: Patients can expect a gradual reduction in symptoms, with ulcers healing over several weeks. While ciprofloxacin is generally effective, results may take longer compared to first-line treatments.

Erythromycin

Definition: Erythromycin is a macrolide antibiotic that inhibits bacterial protein synthesis, halting bacterial growth.

How and When It’s Used: Erythromycin is often used as an alternative treatment for Donovanosis, particularly in pregnant women or individuals who cannot tolerate other antibiotics. It is typically taken four times a day for at least three weeks or until the ulcers have healed.

Expected Outcomes: Patients should see gradual improvement, with ulcers healing over several weeks. Erythromycin is generally well-tolerated, though results may take longer compared to other antibiotics.

Metronidazole

Definition: Metronidazole is an antibiotic that disrupts bacterial DNA, effectively killing the bacteria. It is commonly used to treat anaerobic bacterial infections.

How and When It’s Used: Metronidazole is often used as a second-line treatment for Donovanosis, particularly in cases where the infection is resistant to other antibiotics. It is typically taken twice daily for at least three weeks or until the lesions have healed.

Expected Outcomes: Patients can expect improvement within a few days, with ulcers healing over several weeks. Metronidazole is generally effective, but severe cases may take longer to resolve.

Tetracycline

Definition: Tetracycline is an antibiotic that inhibits bacterial protein synthesis, effectively stopping bacterial growth.

How and When It’s Used: Tetracycline is sometimes used as an alternative treatment for Donovanosis, particularly when other antibiotics are ineffective or not tolerated. It is typically taken four times a day for at least three weeks or until the lesions have healed.

Expected Outcomes: Patients should see gradual improvement, with ulcers healing over several weeks. Tetracycline is generally effective, but results may take longer compared to other antibiotics.

Chloramphenicol

Definition: Chloramphenicol is a broad-spectrum antibiotic that inhibits bacterial protein synthesis, stopping bacterial growth.

How and When It’s Used: Chloramphenicol is typically reserved for severe cases of Donovanosis or when other antibiotics have failed. It is usually taken four times a day for at least three weeks or until the lesions have healed.

Expected Outcomes: Patients can expect gradual improvement, with ulcers healing over several weeks. Chloramphenicol is generally effective, but severe cases may take longer to resolve.

Streptomycin

Definition: Streptomycin is an aminoglycoside antibiotic that inhibits bacterial protein synthesis, effectively killing the bacteria.

How and When It’s Used: Streptomycin is typically used as a second-line treatment for Donovanosis, particularly when other antibiotics have failed. It is usually administered via injection, making it less convenient for outpatient treatment.

Expected Outcomes: Patients can expect gradual improvement, with ulcers healing over several weeks. Streptomycin is generally effective, but severe cases may take longer to resolve.

Gentamicin

Definition: Gentamicin is an aminoglycoside antibiotic that inhibits bacterial protein synthesis, effectively killing the bacteria.

How and When It’s Used: Gentamicin is typically used as a second-line treatment for Donovanosis, particularly when other antibiotics have failed. It is usually administered via injection, making it less convenient for outpatient treatment.

Expected Outcomes: Patients can expect gradual improvement, with ulcers healing over several weeks. Gentamicin is generally effective, but severe cases may take longer to resolve.

Rifampicin

Definition: Rifampicin is an antibiotic that inhibits bacterial RNA synthesis, effectively killing the bacteria.

How and When It’s Used: Rifampicin is typically used as a second-line treatment for Donovanosis, particularly when other antibiotics have failed. It is usually taken once or twice daily for at least three weeks or until the lesions have healed.

Expected Outcomes: Patients can expect gradual improvement, with ulcers healing over several weeks. Rifampicin is generally effective, but severe cases may take longer to resolve.

Improving Donovanosis Symptoms and Seeking Medical Help

While antibiotics are the cornerstone of Donovanosis treatment, certain home care measures can help alleviate symptoms and support healing. Keeping the affected area clean and dry is crucial to prevent secondary infections. Applying warm compresses to the ulcers can help reduce pain and swelling. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can also help manage discomfort. It is important to avoid sexual contact until the infection has completely healed to prevent spreading the disease.

If you suspect you have Donovanosis or are experiencing symptoms such as genital ulcers, seek medical attention promptly. Telemedicine offers a convenient way to consult with a healthcare provider from the comfort of your home. Early diagnosis and treatment are essential to prevent complications and ensure a full recovery.

Living with Donovanosis: Tips for Better Quality of Life

Living with Donovanosis can be challenging, but there are steps you can take to improve your quality of life. Following your prescribed treatment plan is critical for a full recovery. Be sure to take all medications as directed, even if your symptoms begin to improve. Practicing good hygiene and keeping the affected area clean can help prevent secondary infections and promote healing. Emotional support is also important, as dealing with a sexually transmitted infection can be stressful. Consider reaching out to a counselor or support group if you feel overwhelmed.

Conclusion

Donovanosis is a rare but serious sexually transmitted infection that causes painful genital ulcers. Early diagnosis and treatment are crucial to prevent complications and ensure a full recovery. Fortunately, several effective antibiotic treatments are available, and most patients can expect improvement within a few weeks. If you are experiencing symptoms of Donovanosis, don’t hesitate to seek medical help. Our telemedicine practice offers a convenient and confidential way to consult with a healthcare provider and get the treatment you need. Reach out today to schedule an appointment and take the first step toward recovery.

James Kingsley

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