Granuloma inguinale (also known as “Donovanosis”) is a sexually transmitted bacterial infection of endemic proportions in many underdeveloped countries. The pathognomic feature of the disease are Donovan bodies on Giemsa or Wright stain, intracellular inclusions representing the causative gram negative Klebsiella granulomatis bacteria that have been engulfed by mononuclear phagocytes. Clinically, granuloma inguinale is characterized by painless genital ulcers that appear 10 to 40 days after contact and that can be mistaken for syphilis. However, unlike syphilis, they can progress to mutilate and destroy tissue and are often superinfected with other pathogenic organisms. The lesions occur in the region of contact, which is typically the penile shaft or perineum, and contain Donovan bodies when the superﬁcial layers of the ulcer are scraped or when stained granulation tissue is examined.
The earliest sign of the infection is a tiny macule that develops into a papule and ﬁnally a creeping, serpiginous, painless ulcer. Extensive and luxuriant granulations cover the ulcer base with considerable epithelial proliferation around the margin. No large abscesses develop, as in chancroid, but small necrotic areas are observed. Systemic symptoms and lymphadenopathy do not ordinarily accompany this infection. Granuloma inguinale must be differentiated from the other chronic ulcerative infections such as chancroid, chronic streptococcal infection and syphilis. In later stages, granuloma inguinale may look like advanced genital cancers, lymphogranuloma venereum, and cutaneous amebiasis. In cases that do not respond to curative antibiotics and surgical excision, carcinoma must be considered. The diagnosis is made by smears of scrapings from lesions, as the bacteria do not grow in ordinary culture media. Although an infection may begin to reside after 7 days of treatment, a full 12 weeks of antibiotics is essential. Approximately 10% of healed lesions may relapse months later because the Donovan bodies persist beneath healed skin, mandating further treatment. Complications of granuloma inguinale infection include genital mutilation and scarring, loss of skin color in the genital area and genital elephantiasis from scarring. Occasionally, bacteria spread hematogenously to the bones, joints, or liver; without treatment, anemia, wasting, and uncommonly death may occur.