Treating Donovanosis: Sometimes Referred to as a Flesh-Eating STI

STI Ulcers, Testing, and Treatment

Medically reviewed by Matthew Wosnitzer, MD

Donovanosis is a sexually transmitted infection (STI) that causes ulcers (sores) to form on the skin around the genitals. Ulcers can also appear around the mouth. These sores can destroy the affected skin and nearby tissue.

Also called granuloma inguinale, donovanosis is caused by a bacteria called Klebsiella granulomatis (K. granulomatis). It is sometimes referred to as a flesh-eating STI because of the ulcer-like sores it causes, but the bacterium does not actually eat flesh.

Donovanosis is transmitted through sexual contact, including vaginal, anal, and oral sex. Anyone can contract it, but people with a penis are twice as likely to acquire the infection.

This article will cover symptoms of donovanosis, transmission, testing, treatment, and more.

Symptoms: How Donovanosis Ulcers Look

A donovanosis infection starts as firm, raised lumps that become red and tender. Genital ulcers are the most common symptom, and these ulcers may spread to the groin, anus, and mouth.

The four types of donovanosis are characterized by how the ulcers present. The most common type is ulcerogranulomatous, which leads to ulcers with a beefy red appearance and highly vascular tissue (containing many blood vessels). These ulcers are painless but can bleed.

Other types of donovanosis ulcers are:

• Hypertrophic or verrucous ulcers: These have irregular edges and can be dry.

• Necrotic ulcers: These ulcers are deeper, painful to touch, and foul-smelling.

• Sclerotic or cicatricial ulcers: These are painless fibrous ulcers resembling scar tissue.

Additional ulcer types cited in the literature include:

• Nodular ulcers: These consist of soft, red papules and nodules that may present with granulation tissue—new connective tissue with microscopic blood vessels.

• Elephantiasis manifestations: These primarily affect people assigned female at birth and can lead to scar tissue formation. These ulcers heal with intense fibrosis, destroying lymphatic pathways. This is the most frequent complication of donovanosis. There have also been reports of squamous cell carcinomas (a type of skin cancer) of the vulva after a long course of the disease.

Transmission: How Do People Acquire a Donovanosis Infection?

Donovanosis is rare in the United States, with only around 100 cases annually. It is more common in tropical and subtropical parts of the world. The majority of donovanosis cases are in people age 20 to 40.

Donovanosis not only spreads during sexual contact but also during the birthing process or directly after birth.

Sexual Activity

Donavanosis is mainly transmitted from person to person via vaginal or anal intercourse. It may be transmitted through oral sex as well, but this is much rarer. Your risk for the infection increases if you have multiple partners and engage in condomless sex.

According to the Centers for Disease Control and Prevention (CDC), donovanosis can co-occur with other bacterial infections and other STIs, including human immunodeficiency virus (HIV), chlamydia, and gonorrhea.

Related: The Difference Between STD and STI

Nonsexual Transmission

Donovanosis can also be transmitted via direct skin-to-skin contact. This is rare and mainly affects children and adults who are not sexually active. Repeated contact with skin lesions would have to be made for transmission to occur.

Transmitting the infection from a birthing parent to the newborn during childbirth occurs if the bacterium is present in the genital tract and the baby is exposed to it. This type of transmission is also rare.

Preventing Transmission

Donovanosis can be prevented by practicing safer sex, which includes the proper use of condoms—both external (male) and internal (female) types—and other barrier methods (i.e., a dental dam for oral sex). Condoms should be worn from the beginning to the end of sexual activity.

This STI is also preventable by refraining from sex with someone who has active lesions. Research shows that donovanosis is most infectious when ulcers are present.

Donovanosis Testing: When to Go

Donovanosis needs immediate medical care to prevent complications. You should see a healthcare provider immediately if you experience symptoms of the infection. You should get tested if you have had sexual contact with someone who has donovanosis.

Diagnosing donovanosis involves taking skin scrapings from sores to observe cells under a microscope. The presence of Donovan bodies can help your healthcare provider confirm a diagnosis. They will appear as dark stain cells on tissue crush preparation or a skin biopsy (removing a sample of skin for analysis in a lab).

Suspected Symptoms

The most common symptom of donovanosis is slow-growing genital ulcers. Symptoms can start as early as two weeks after infection, but it could be up to 50 days.

Donovanosis ulcers will start as small, painless, red lumps on the skin of the genitals. The lumps will grow, break down, and form ulcers. The ulcers will spread and lead to multiple ulcers on the vulva, perineum (the thin layer of skin between your genitals and anus), and penis.

Ulcers may present as a beefy red color. They are painless and may bleed. The tissue around the ulcers might feel velvety.

The lesions will expand and destroy the genital tissue and spread to the groin. The skin of the genitals and nearby tissue may start to lose color.

Unprotected Sex Outside of the United States

Donovanosis is rare in the United States, with only about 100 cases reported annually. The disease is most commonly found in tropical and subtropical countries, including Guyana and French Guiana.

Most cases reported in the United States occur in people who have traveled to or come from areas where the disease is common. To prevent a donovanosis infection while traveling out of the country, it is crucial to avoid unprotected sex.

If you decide to have sex, be sure to use condoms and other barrier methods. Avoid sex with someone who has visible lesions or whom you think might have an STI.

Chancroid vs. Donovanosis

Donovanosis is sometimes confused with another STI called chancroid, which also causes open sores on and around the genitals. It is rare in the United States. While global incidences have decreased in recent years, it is found in some areas of Africa and the Caribbean.

The bacterium that causes chancroid is Haemophilus ducreyi. It attacks genital area tissue and causes open sores called chancroids. These may bleed or release a contagious fluid that can transmit the infection through oral, vaginal, or anal intercourse. Chancroid may also spread from skin contact with a person with the infection.

Unlike donovanosis, chancroid sores will present quickly, about four to 10 days after exposure to the infection. In people with a penis, chancroid presents as small, red bumps that may turn into open sores in a day or two. People with a vagina may experience several red bumps on the labia, between the labia and anus, and on the inside of the thighs. If bumps become open sores, they cause pain with urination and bowel movements.

Antibiotics for Donovanosis

Donovanosis is a bacterial infection that can be treated with antibiotics. The recommended first-line therapy antibiotic is azithromycin. It is given for three weeks or until the ulcers have completely healed.

A second option for treating donovanosis is doxycycline. It is used for a minimum of 21 days or until complete healing. Additional options are ciprofloxacin and sulfamethoxazole-trimethoprim.

Related: What Are the Most Common Antibiotics for Urinary Tract Infections?

Antibiotic treatments are given in pill form and taken by mouth. If there is no response to treating sores in the first days of treatment, an intravenous (IV) treatment like Garamycin (gentamicin) may be prescribed.

Surgery may be needed to remove scar tissue. This is often the case for people who wait to receive treatment.

Secondary Complications and Persistent Symptoms

Treatment for donovanosis requires a long course of antibiotics that may continue to ensure that no new sores appear. Donovanosis can recur, and you will need a new antibiotic course. Successful treatment means all ulcers are gone and do not return. You may want to avoid sexual intercourse until your healthcare provider tells you that you are no longer infected.

Donovanosis ulcers typically do not spread past the genitals, perineum, and anal region. However, an extragential infection (one occurring elsewhere than on or around the genitals) can extend to the pelvis, organs, bones, and mouth if the disease is left untreated.

Bacteria spreading to the organs can be life-threatening. In very rare cases, bone is involved, leading to osteolytic lesions (areas of damaged bone). If donovanosis goes untreated, it can progress and cause permanent damage to tissues.

Summary

Donovanosis is an STI, although it is possible to transmit it with non-sexual contact. It is rare in the United States and mainly found in tropical and subtropical parts of the world.

Symptoms will appear two weeks to 50 days after exposure to the infection. The earliest symptoms are painless red bumps that progress to ulcers.

Donovanosis is treated with a long course of antibiotics. Treatment is given for at least 21 days or until sores have cleared. Sores can return, and a second round of antibiotics will be needed to treat the infection.

You can prevent donovanosis by avoiding unprotected sex. Use condoms and other barrier protection methods from the beginning of the sexual activity to the end. Avoid sexual contact with anyone who has visible genital lesions.

If you experience lesions in your genital area, you should reach out to a healthcare provider right away to get diagnosed and treated. You want to avoid sexual contact until all lesions have cleared and not returned over a reasonable time period.

Read the original article on Verywell Health.