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Granuloma Inguinale

Last updated Sept. 18, 2018

Approved by: Krish Tangella MD, MBA, FCAP

CDC/ Susan Lindsley

Tissue sample from a granuloma inguinale lesion, shows a white blood cell containing the pathognomonic finding of Donovan bodies, which are encapsulated, Gram-negative rods, representing the responsible bacterium Klebsiella granulomatis.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Donovanosis

What is Granuloma Inguinale? (Definition/Background Information)

  • Granuloma Inguinale is a rare, sexually transmitted disease (STD) caused by Klebsiella granulomatis bacteria. Unprotected sexual intercourse with multiple partners is the most important risk factor for contracting this disease
  • Most cases are reported in the tropics, in regions such as Guyana, southeast India, and New Guinea. Young to middle aged men are most commonly affected with this infection
  • The most important symptom of this disease is the presence of painless, beefy red sores in the genital region or anus, which may bleed easily if injured
  • Antibiotics, such as streptomycin and erythromycin, are the mainstay of treatment for Granuloma Inguinale. These are typically recommended for a period of 3-4 weeks
  • Granuloma Inguinale infection, when left untreated may lead to complications, such as severe scarring and disfigurement, in the anal and genital region. Significant scarring may even cause obstruction of the urinary tract
  • The prognosis of Granuloma Inguinale is generally good with early and appropriate treatment

Who gets Granuloma Inguinale? (Age and Sex Distribution)

  • Granuloma Inguinale is common in tropical and subtropical regions of the world that include southeast India, Guyana, and New Guinea
  • Both genders are affected, although the prevalence rate is double in young men (in the 20-40 year age group) than women
  • This condition is rarely seen in children or the elderly adults
  • All racial and ethnic groups can be affected; no particular preference is noted

What are the Risk Factors for Granuloma Inguinale? (Predisposing Factors)

  • Unprotected sexual intercourse with multiple partners is the most important risk factor for contracting Granuloma Inguinale
  • Illegal drug abuse that is associated with risky sexual behavior is therefore a risk factor for developing this condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Granuloma Inguinale? (Etiology)

  • Granuloma Inguinale is caused by a rod-shaped bacterium called Klebsiella granulomatis
  • The mode of transmission is through the sexual route; Granuloma Inguinale is a sexually-transmitted infection
  • This bacterium is also known as Donovania granulomatis, and hence, Granuloma Inguinale is also known as Donovanosis

What are the Signs and Symptoms of Granuloma Inguinale?

When an individual gets infected with the causative bacterium, it may take up to 12 weeks for the symptoms of Granuloma Inguinale to become apparent. In many cases, initially the sores may go unnoticed, as they may not be painful or at a directly visible location.

In affected individuals, initial signs are typically observed in the genital region. The signs and symptoms of Granuloma Inguinale may include:

  • Lumpy red bumps around the groin, genital, and/or anal region
  • Sores around the genitals or anus
  • Bleeding from the sores
  • Skin discoloration around the genitals
  • Foul-smelling ulcers characterized by granulation tissue around the edges
  • There can be associated fever due to the infection

How is Granuloma Inguinale Diagnosed?

An accurate diagnosis of Granuloma Inguinale might involve the following procedures and exams:

  • Complete evaluation of medical history, along with a thorough physical examination
  • Genital examination to check for skin ulcers that are painless, likely to bleed, irregular in shape, and/or are fairly large in size
  • Scraping or biopsy of the lesion: It is the confirmatory diagnostic test for Granuloma Inguinale. The technique involves injecting a local anesthetic so that a tissue sample may be taken. The sample is stained with Wrights stain, which will turn Donovan bodies dark purple. Donovan bodies present in skin tissue can help confirm Granuloma Inguinale diagnosis

What are the possible Complications of Granuloma Inguinale?

The possible complications associated with Granuloma Inguinale include:

  • Severe damage and genital scarring
  • If damage is substantial, parts of the urinary tract may become blocked
  • Skin discoloration in the genital region
  • Cosmetic issues causing severe emotional and psychological stress

How is Granuloma Inguinale Treated?

  • Oral antibiotics, such as given below, are most effectively used to treat Granuloma Inguinale:
    • Ampicillin
    • Erythromycin
    • Tetracycline
    • Streptomycin
  • The antibiotics are typically prescribed for a duration of 3-4 weeks
  • The antibiotic course should be completed as prescribed by the healthcare professional, even if the visible signs and symptoms of the condition disappear

How can Granuloma Inguinale be Prevented?

The following are ways to prevent Granuloma Inguinale occurrence:

  • Unprotected sexual intercourse with multiple partners should be avoided
  • If an individual does get infected, his/her sexual partner(s) should be informed, screened and even treated (if necessary)
  • Routine screening after completion of treatment should be undertaken to prevent re-infection
  • Drug abuse should be avoided, as this habit most often leads to risky sexual behavior

What is the Prognosis of Granuloma Inguinale? (Outcomes/Resolutions)

  • The prognosis of Granuloma Inguinale is considered to be very good with appropriate treatment
  • Early diagnosis and proper treatment is very important in preventing genital scarring and damage
  • Recurrence is a possibility for up to two years after being treated for the disease

Additional and Relevant Useful Information for Granuloma Inguinale:

  • Granuloma Inguinale is extremely rare in the United States, with only about 100 cases being reported each year
  • Klebsiella granulomatis, also known as Donovania granulomatis, is named after the noted physician Charles Donovan, who discovered this bacterium while practicing at the Madras Medical College, Chennai, India

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: April 26, 2016
Last updated: Sept. 18, 2018