Skip to main content
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2002 Dec;78(6):452–457. doi: 10.1136/sti.78.6.452

Donovanosis

N O'Farrell
PMCID: PMC1758360  PMID: 12473810

Abstract

Donovanosis, a chronic cause of genital ulceration, has recently been the subject of renewed interest after a long period of relative obscurity. The causative organism, Calymmatobacterium granulomatis, has been cultured for the first time in many years and a polymerase chain reaction diagnostic using a colorimetric detection system has been developed. Phylogenetic analysis confirms close similarities with the genus Klebsiella and a proposal made that C granulomatis be reclassified as Klebsiella granulomatis comb nov. Azithromycin has emerged as the drug of choice and should be used if the diagnosis is confirmed or suspected. In donovanosis endemic areas, syndromic management protocols for genital ulceration may need to be adapted locally. A significant donovanosis epidemic was reported in Durban from 1988–97 but the current status of this epidemic is unclear. The donovanosis elimination programme among Aboriginals in Australia appears successful and is a model that could be adopted in other donovanosis endemic areas. Overall, the incidence of donovanosis seems to be decreasing. Increased attention would undoubtedly be paid to donovanosis if policy makers recognised more readily the importance of genital ulcers in fuelling the HIV epidemic.

Full Text

The Full Text of this article is available as a PDF (135.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bastian I., Bowden F. J. Amplification of Klebsiella-like sequences from biopsy samples from patients with donovanosis. Clin Infect Dis. 1996 Dec;23(6):1328–1330. doi: 10.1093/clinids/23.6.1328. [DOI] [PubMed] [Google Scholar]
  2. Bowden F. J., Mein J., Plunkett C., Bastian I. Pilot study of azithromycin in the treatment of genital donovanosis. Genitourin Med. 1996 Feb;72(1):17–19. doi: 10.1136/sti.72.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bowden F. J., Savage J. Azithromycin for the treatment of donovanosis. Sex Transm Infect. 1998 Feb;74(1):78–79. [PubMed] [Google Scholar]
  4. Bowden F. J., Savage J. Is the eradication of donovanosis possible in Australia? Aust N Z J Public Health. 1998 Feb;22(1):7–9. doi: 10.1111/j.1467-842x.1998.tb01136.x. [DOI] [PubMed] [Google Scholar]
  5. Brathwaite A. R., Figueroa J. P., Ward E. A comparison of prevalence rates of genital ulcers among persons attending a sexually transmitted disease clinic in Jamaica. West Indian Med J. 1997 Sep;46(3):67–71. [PubMed] [Google Scholar]
  6. Carter J. S., Bowden F. J., Bastian I., Myers G. M., Sriprakash K. S., Kemp D. J. Phylogenetic evidence for reclassification of Calymmatobacterium granulomatis as Klebsiella granulomatis comb. nov. Int J Syst Bacteriol. 1999 Oct;49(Pt 4):1695–1700. doi: 10.1099/00207713-49-4-1695. [DOI] [PubMed] [Google Scholar]
  7. Carter J. S., Kemp D. J. A colorimetric detection system for Calymmatobacterium granulomatis. Sex Transm Infect. 2000 Apr;76(2):134–136. doi: 10.1136/sti.76.2.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Carter J., Bowden F. J., Sriprakash K. S., Bastian I., Kemp D. J. Diagnostic polymerase chain reaction for donovanosis. Clin Infect Dis. 1999 May;28(5):1168–1169. doi: 10.1086/517768. [DOI] [PubMed] [Google Scholar]
  9. Freinkel A. L., Dangor Y., Koornhof H. J., Ballard R. C. A serological test for granuloma inguinale. Genitourin Med. 1992 Aug;68(4):269–272. doi: 10.1136/sti.68.4.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Freinkel A. L. The enigma of granuloma inguinale in South Africa. S Afr Med J. 1990 Mar 17;77(6):301–303. [PubMed] [Google Scholar]
  11. GOLDBERG J. Studies on granuloma inguinale. V. Isolation of a bacterium resembling Donovania granulomatis from the faeces of a patient with granuloma inguinale. Br J Vener Dis. 1962 Jun;38:99–102. doi: 10.1136/sti.38.2.99. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. GREENBLATT R. B., BARFIELD W. E. Newer methods in the diagnosis and treatment of granuloma inguinale. Br J Vener Dis. 1952 Sep;28(3):123–128. doi: 10.1136/sti.28.3.123. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. GREENBLATT R. B., DIENST R. B., WEST R. M. A simple stain for Donovan bodies for the diagnosis of granuloma inguinale. Am J Syph Gonorrhea Vener Dis. 1951 May;35(3):291–293. [PubMed] [Google Scholar]
  14. Goldberg J., Annamunthodo H. Studies on granuloma inguinale. 8. Serological reactivity of sera from patients with carcinoma of penis when tested with Donovania antigens. Br J Vener Dis. 1966 Sep;42(3):205–209. doi: 10.1136/sti.42.3.205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Govender D., Naidoo K., Chetty R. Granuloma inguinale (donovanosis): an unusual cause of otitis media and mastoiditis in children. Am J Clin Pathol. 1997 Nov;108(5):510–514. doi: 10.1093/ajcp/108.5.510. [DOI] [PubMed] [Google Scholar]
  16. Hart G. Donovanosis. Clin Infect Dis. 1997 Jul;25(1):24–32. doi: 10.1086/514495. [DOI] [PubMed] [Google Scholar]
  17. Hoosen A. A., Mphatsoe M., Kharsany A. B., Moodley J., Bassa A., Bramdev A. Granuloma inguinale in association with pregnancy and HIV infection. Int J Gynaecol Obstet. 1996 May;53(2):133–138. doi: 10.1016/0020-7292(95)02648-7. [DOI] [PubMed] [Google Scholar]
  18. Hsu S. L., Chia J. K. Trovofloxacin for the treatment of chronic granuloma inguinale. Sex Transm Infect. 2001 Apr;77(2):137–137. doi: 10.1136/sti.77.2.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hudson B. J., van der Meijden W. I., Lupiwa T., Howard P., Tabua T., Tapsall J. W., Phillips E. A., Lennox V. A., Backhouse J. L., Pyakalyia T. A survey of sexually transmitted diseases in five STD clinics in Papua New Guinea. P N G Med J. 1994 Sep;37(3):152–160. [PubMed] [Google Scholar]
  20. Jamkhedkar P. P., Hira S. K., Shroff H. J., Lanjewar D. N. Clinico-epidemiologic features of granuloma inguinale in the era of acquired immune deficiency syndrome. Sex Transm Dis. 1998 Apr;25(4):196–200. doi: 10.1097/00007435-199804000-00004. [DOI] [PubMed] [Google Scholar]
  21. Kharsany A. B., Hoosen A. A., Kiepiela P., Kirby R., Sturm A. W. Phylogenetic analysis of Calymmatobacterium granulomatis based on 16S rRNA gene sequences. J Med Microbiol. 1999 Sep;48(9):841–847. doi: 10.1099/00222615-48-9-841. [DOI] [PubMed] [Google Scholar]
  22. Kharsany A. B., Hoosen A. A., Kiepiela P., Naicker T., Sturm A. W. Growth and cultural characteristics of Calymmatobacterium granulomatis--the aetiological agent of granuloma inguinale (Donovanosis). J Med Microbiol. 1997 Jul;46(7):579–585. doi: 10.1099/00222615-46-7-579. [DOI] [PubMed] [Google Scholar]
  23. Kharsany A. B., Hoosen A. A., Naicker T., Kiepiela P., Sturm A. W. Ultrastructure of Calymmatobacterium granulomatis: comparison of culture with tissue biopsy specimens. J Med Microbiol. 1998 Dec;47(12):1069–1073. doi: 10.1099/00222615-47-12-1069. [DOI] [PubMed] [Google Scholar]
  24. Kumar Bhushan, Sahoo Bijaylaxmi, Gupta Somesh, Jain Rajesh. Rising incidence of genital herpes over two decades in a sexually transmitted disease clinic in north India. J Dermatol. 2002 Feb;29(2):74–78. doi: 10.1111/j.1346-8138.2002.tb00169.x. [DOI] [PubMed] [Google Scholar]
  25. Lal S., Nicholas C. Epidemiological and clinical features in 165 cases of granuloma inguinale. Br J Vener Dis. 1970 Dec;46(6):461–463. doi: 10.1136/sti.46.6.461. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Maddocks I., Anders E. M., Dennis E. Donovanosis in Papua New Guinea. Br J Vener Dis. 1976 Jun;52(3):190–196. doi: 10.1136/sti.52.3.190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Meheus A., Van Dyck E., Ursi J. P., Ballard R. C., Piot P. Etiology of genital ulcerations in Swaziland. Sex Transm Dis. 1983 Jan-Mar;10(1):33–35. doi: 10.1097/00007435-198301000-00007. [DOI] [PubMed] [Google Scholar]
  28. Mein J. K., Anstey N. M., Bowden F. J. Missing the diagnosis of donovanosis in northern Australia. Med J Aust. 1999 Jan 4;170(1):48–48. doi: 10.5694/j.1326-5377.1999.tb126875.x. [DOI] [PubMed] [Google Scholar]
  29. Merianos A., Gilles M., Chuah J. Ceftriaxone in the treatment of chronic donovanosis in central Australia. Genitourin Med. 1994 Apr;70(2):84–89. doi: 10.1136/sti.70.2.84. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. O'Farrell N. Clinico-epidemiological study of donovanosis in Durban, South Africa. Genitourin Med. 1993 Apr;69(2):108–111. doi: 10.1136/sti.69.2.108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. O'Farrell N., Coetzee K. HIV and granuloma inguinale in Durban. S Afr Med J. 1990 Aug 18;78(4):220–220. [PubMed] [Google Scholar]
  32. O'Farrell N. Donovanosis: an update. Int J STD AIDS. 2001 Jul;12(7):423–427. doi: 10.1258/0956462011923435. [DOI] [PubMed] [Google Scholar]
  33. O'Farrell N. Genital ulcers, stigma, HIV, and STI control in sub-Saharan Africa. Sex Transm Infect. 2002 Apr;78(2):143–146. doi: 10.1136/sti.78.2.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. O'Farrell N. Global eradication of donovanosis: an opportunity for limiting the spread of HIV-1 infection. Genitourin Med. 1995 Feb;71(1):27–31. doi: 10.1136/sti.71.1.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. O'Farrell N., Hoosen A. A., Coetzee K. D., van den Ende J. Genital ulcer disease in men in Durban, South Africa. Genitourin Med. 1991 Aug;67(4):327–330. doi: 10.1136/sti.67.4.327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. O'Farrell N., Hoosen A. A., Coetzee K. D., van den Ende J. Genital ulcer disease in women in Durban, South Africa. Genitourin Med. 1991 Aug;67(4):322–326. doi: 10.1136/sti.67.4.322. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. O'Farrell N., Hoosen A. A., Coetzee K. D., van den Ende J. Genital ulcer disease: accuracy of clinical diagnosis and strategies to improve control in Durban, South Africa. Genitourin Med. 1994 Feb;70(1):7–11. doi: 10.1136/sti.70.1.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. O'Farrell N., Hoosen A. A., Coetzee K., van den Ende J. A rapid stain for the diagnosis of granuloma inguinale. Genitourin Med. 1990 Jun;66(3):200–201. doi: 10.1136/sti.66.3.200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. O'Farrell N. Targeted interventions required against genital ulcers in African countries worst affected by HIV infection. Bull World Health Organ. 2001;79(6):569–577. [PMC free article] [PubMed] [Google Scholar]
  40. O'Farrell N. Trends in reported cases of donovanosis in Durban, South Africa. Genitourin Med. 1992 Dec;68(6):366–369. doi: 10.1136/sti.68.6.366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. O'Farrell N., Windsor I., Becker P. HIV-1 infection among heterosexual attenders at a sexually transmitted diseases clinic in Durban. S Afr Med J. 1991 Jul 6;80(1):17–20. [PubMed] [Google Scholar]
  42. PACKER H., GOLDBERG J. Studies of the antigenic relationship of D. grandulomatis to members of the tribe Eschericheae. Am J Syph Gonorrhea Vener Dis. 1950 Jul;34(4):342–350. [PubMed] [Google Scholar]
  43. Parkash S., Radhakrishna K. Problematic ulcerative lesions in sexually transmitted diseases: surgical management. Sex Transm Dis. 1986 Jul-Sep;13(3):127–133. doi: 10.1097/00007435-198607000-00003. [DOI] [PubMed] [Google Scholar]
  44. Ramanan C., Sarma P. S., Ghorpade A., Das M. Treatment of donovanosis with norfloxacin. Int J Dermatol. 1990 May;29(4):298–299. doi: 10.1111/j.1365-4362.1990.tb02568.x. [DOI] [PubMed] [Google Scholar]
  45. Rosen T., Tschen J. A., Ramsdell W., Moore J., Markham B. Granuloma inguinale. J Am Acad Dermatol. 1984 Sep;11(3):433–437. doi: 10.1016/s0190-9622(84)70186-1. [DOI] [PubMed] [Google Scholar]
  46. Sehgal V. N., Jain M. K. Tissue section Donovan bodies--identification through slow-Giemsa (overnight) technique. Dermatologica. 1987;174(5):228–231. doi: 10.1159/000249185. [DOI] [PubMed] [Google Scholar]
  47. Sehgal V. N., Prasad A. L. Donovanosis. Current concepts. Int J Dermatol. 1986 Jan-Feb;25(1):8–16. doi: 10.1111/j.1365-4362.1986.tb03396.x. [DOI] [PubMed] [Google Scholar]
  48. Thappa D. M., Singh S., Singh A. HIV infection and sexually transmitted diseases in a referral STD centre in south India. Sex Transm Infect. 1999 Jun;75(3):191–191. doi: 10.1136/sti.75.3.191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Vogel L. C., Richens J. Donovanosis in Dutch South New Guinea: history, evolution of the epidemic and control. P N G Med J. 1989 Sep;32(3):203–218. [PubMed] [Google Scholar]
  50. Wistrand R., Wegerhoff F. Granuloma inguinale in the eastern Transvaal. S Afr Med J. 1985 Jan 5;67(1):13–15. [PubMed] [Google Scholar]
  51. de Boer A. L., de Boer F., Van der Merwe J. V. Cytologic identification of Donovan bodies in granuloma inguinale. Acta Cytol. 1984 Mar-Apr;28(2):126–128. [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES