Donovanosis: Symptoms, Causes, and Treatment Options

Donovanosis is a sexually transmitted bacterial infection, also called granuloma inguinale, that usually causes slowly enlarging painless sores on the genitals or nearby skin. It is treatable with antibiotics, but early diagnosis matters because untreated infection can damage tissue and increase the risk of spreading or acquiring other sexually transmitted infections.

Overview

Donovanosis is a sexually transmitted infection caused by the bacterium Klebsiella granulomatis. It is also known as granuloma inguinale. The infection most often affects the genital and anal area, although in some cases it can involve nearby skin or, more rarely, other body sites through direct spread.

A common feature of donovanosis is the development of slowly progressive sores that are often painless. Because the ulcers may not hurt, some people delay seeking care. Without treatment, the infection can continue to spread locally, cause tissue destruction, and leave scarring.

Donovanosis is less common than many other sexually transmitted infections, but it remains important because its symptoms can resemble those of other conditions, including genital herpes and syphilis. A medical assessment is the best way to confirm the diagnosis and start the right treatment.

Symptoms and what the sores may look like

The main symptom of donovanosis is one or more genital sores that tend to enlarge over time. These sores are often described as beefy red, moist, and prone to bleeding with touch. Unlike some other genital ulcer conditions, they are usually painless, which can make them easier to overlook.

The lesions may appear on the penis, vulva, vagina, cervix, scrotum, groin, or around the anus, depending on sexual contact and the area exposed. In some people, the infection starts as a small bump or nodule that gradually breaks down into an ulcer. The border may be raised, and the base may look raw or velvety.

Some people may also notice:

• Slowly enlarging skin or mucosal ulcers
• Easy bleeding from the lesion
• Unpleasant odor if a secondary bacterial infection develops
• Swelling or tissue thickening in the affected area
• Scarring or deformity in long-standing untreated cases

Although donovanosis itself often does not cause fever or general illness, any genital ulcer should be assessed promptly. Similar-looking sores can occur with other infections or, less commonly, with noninfectious skin conditions and some cancers.

Causes and risk factors

Donovanosis is caused by infection with Klebsiella granulomatis, a bacterium spread mainly through sexual contact. Transmission usually happens with vaginal or anal sex involving direct skin-to-skin or mucosal contact with an infected lesion. The infection appears to enter through tiny breaks in the skin or mucous membranes.

Risk is generally higher for people who have unprotected sex, multiple sexual partners, or sexual contact in areas where donovanosis is more common. Delayed diagnosis in a partner can also increase the chance of ongoing transmission, especially because the sores may be painless and mistaken for minor skin irritation.

Having donovanosis may increase vulnerability to other sexually transmitted infections because ulcerated skin creates an easier entry point for germs. For this reason, clinicians often recommend testing for related infections such as HIV and other common STIs when genital ulcers are present.

How donovanosis is diagnosed

Diagnosis begins with a medical history and physical examination. A clinician will ask about the appearance and timing of the sore, recent sexual contact, travel history if relevant, and whether there are other symptoms such as discharge, pain, fever, or swollen glands. Because several conditions can cause genital ulcers, careful evaluation is important.

Laboratory confirmation may involve taking a sample from the lesion. Under microscopy, characteristic “Donovan bodies” may sometimes be seen in tissue or smear samples. In some settings, biopsy or specialized testing may be used, especially when the diagnosis is uncertain or when the sore does not respond as expected to treatment.

Doctors also usually test for other possible causes of genital ulcers, including syphilis, herpes, chancroid, and sometimes noninfectious causes. If imaging or additional investigations are needed, they are usually aimed at ruling out complications rather than diagnosing donovanosis itself.

Because diagnosis can be complex, people with persistent or unusual genital sores may benefit from evaluation by specialists in infectious diseases, dermatology, gynecology, or urology. In selected cases, broader assessment through a comprehensive medical check-up may help identify associated infections or complications.

Treatment options

Donovanosis is treated with antibiotics. The exact medicine and duration depend on the individual case, local guidance, pregnancy status, medication tolerance, and whether the infection is mild or advanced. Treatment is generally continued until the lesions have fully healed, because stopping too early can raise the chance of persistent infection or relapse.

During treatment, follow-up visits are important so the clinician can confirm that the sores are shrinking and healing. If a lesion is not improving, the diagnosis may need to be reconsidered, or the person may need evaluation for another infection at the same time. Good wound care and gentle hygiene can support healing.

Partners may also need assessment and testing, even if they do not have obvious symptoms. Sexual contact is usually avoided until treatment is completed and the sores have healed, to reduce the risk of transmission and re-infection.

Depending on symptoms and the site involved, some patients are also evaluated by urology specialists or gynecology specialists for examination of genital tissues, management of complications, or assessment of other possible causes of ulcers.

Possible complications and recovery

When treated early, donovanosis often improves well. However, untreated infection can cause progressive local tissue damage. Over time, ulcers may become larger, deeper, or secondarily infected, and healing may leave scars or changes in the normal shape of the affected area.

Long-standing disease can lead to swelling, narrowing, or chronic skin changes in the genital or anal region. In rare situations, spread beyond the original area may occur. These complications are one reason why prompt medical evaluation is advised even if the sores are painless.

Recovery depends on how early treatment begins and whether there are any coexisting infections. Regular follow-up helps confirm that healing is complete and that there is no recurrence. If symptoms return after apparent improvement, a person should seek re-evaluation rather than restarting treatment on their own.

Prevention and self-care

The best way to lower the risk of donovanosis is to practice safer sex. Using condoms can reduce risk, although they may not fully protect against infections spread by skin-to-skin contact if the sore is outside the area covered. Mutual testing, honest communication with partners, and limiting exposure to untreated lesions are also helpful.

People who notice any genital sore, unusual skin change, or bleeding lesion should avoid sexual contact until they have been assessed. Self-treatment with over-the-counter creams is not reliable because many genital ulcers are not caused by simple irritation or fungal infection. Delayed care can prolong symptoms and increase the risk of passing the infection to others.

General self-care during recovery includes keeping the area clean and dry, avoiding friction or trauma to the lesion, and following the prescribed antibiotic plan exactly. Screening for other STIs is often part of responsible sexual health care when any genital ulcer is found.

For international patients who need coordinated evaluation, Acibadem International’s multidisciplinary specialists in JCI-accredited hospitals diagnose and treat sexually transmitted and genital conditions with individualized care plans.

When to seek medical care

Medical care should be sought promptly for any new genital, anal, or groin sore, especially if it is enlarging, bleeding easily, or not healing. Painless ulcers should not be ignored, because they can still represent a sexually transmitted infection that needs treatment.

Urgent assessment is especially important if there is severe swelling, spreading redness, pus, fever, difficulty urinating, significant pain, or concern about exposure to HIV or another STI. A doctor can help confirm the cause, start treatment, and advise whether sexual partners should also be tested.

Anyone who has completed treatment but notices recurring sores, persistent skin changes, or incomplete healing should return for follow-up. Early reassessment can help prevent complications and ensure the diagnosis is correct.

Frequently asked questions

Is donovanosis the same as granuloma inguinale?

Yes. Donovanosis and granuloma inguinale are two names for the same bacterial sexually transmitted infection. The condition is caused by the bacterium Klebsiella granulomatis.

What does a donovanosis sore look like?

A donovanosis sore is often described as a slowly enlarging, beefy-red ulcer that may look moist and bleed easily when touched. It is commonly painless, which is one reason some people delay seeking care.

Can donovanosis go away on its own?

It should not be expected to clear without treatment. Even if symptoms seem mild, the infection can continue to damage local tissue and may increase the risk of spreading or acquiring other sexually transmitted infections.

How is donovanosis treated?

Donovanosis is treated with antibiotics prescribed by a qualified clinician. Treatment is usually continued until all lesions have healed, and follow-up is important to make sure the infection has fully resolved.

Can condoms prevent donovanosis?

Condoms can lower the risk, but they may not provide complete protection if sores are present on nearby skin not covered by the condom. Avoiding sexual contact when sores are present and getting prompt medical evaluation are also important.

Should sexual partners be tested?

Yes, partners may need evaluation even if they do not have symptoms. A doctor can advise who should be tested, whether treatment is needed, and when it is safe to resume sexual activity.

References

• World Health Organization
• Centers for Disease Control and Prevention
• MedlinePlus
• Merck Manual Professional Edition

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.