Granuloma Inguinale (Donovanosis): Symptoms, Causes and Treatment in the UK

Granuloma inguinale, widely referred to in medical circles as donovanosis, is a chronic bacterial infection that primarily affects the skin and mucous membranes of the genital and anal regions. It is caused by the bacterium Klebsiella granulomatis. Unlike many other sexually transmitted infections (STIs) like herpes or syphilis which can cause painful lesions, the primary hallmark of donovanosis is the presence of painless ulcers that bleed easily upon contact.

In the United Kingdom, donovanosis is considered an imported infection, meaning most cases are diagnosed in individuals who have recently travelled to or arrived from tropical and subtropical climates, such as parts of India, Papua New Guinea, South Africa, and the Caribbean. Because it is relatively rare in British clinical practice, it is often misdiagnosed as other more common genital ulcer diseases, making awareness of its specific symptoms vital for both patients and healthcare providers.

The symptoms of donovanosis develop slowly, with an incubation period ranging anywhere from one week to several months after exposure. The infection typically progresses through several stages:

• Small Red Bumps: The first sign is usually a small, firm, painless pimple or lump on the genitals or around the anus.
• Beefy-Red Ulcers: As the bumps break down, they form expanding, velvety-red sores. These are often described as having a 'beefy' appearance because the granulated tissue is highly vascular and red.
• Easy Bleeding: Although these sores do not usually hurt, they are fragile and will bleed if touched or rubbed by clothing.
• Spread of Infection: If left untreated, the sores can spread to the groin (inguinal area) and may cause the skin to thicken and fold, a process sometimes mistaken for swollen lymph nodes (pseudobuboes).
• Tissue Destruction: In advanced, chronic cases, the bacteria can cause significant destruction of genital tissue and lead to permanent scarring or narrowing of the vaginal or anal openings.

Donovanosis is primarily transmitted through vaginal, anal, or oral sex with an infected partner. While it is less contagious than STIs like chlamydia or gonorrhoea, repeated exposure is often thought to increase the risk of transmission. The Klebsiella granulomatis bacterium thrives in warm, humid environments, which explains its prevalence in specific global regions.

It is important to note that while sexual contact is the main route of transmission, non-sexual transmission (such as skin-to-skin contact in rare circumstances or transmission during childbirth) has been suggested in medical literature, though this is not the primary concern for most UK patients. If you are concerned about symptoms after returning to the UK from abroad, seeking advice from an online doctor or a local sexual health clinic is a responsible first step.

In the UK, the British Association for Sexual Health and HIV (BASHH) and NICE guidelines recommend a thorough clinical evaluation for any patient presenting with genital ulcers. Because donovanosis is rare, a GP or specialist will first want to rule out syphilis, genital herpes, and chancroid.

Diagnosis is confirmed by identifying Donovan bodies—clusters of the bacteria inside large immune cells—under a microscope. To do this, a clinician will usually take a small scraping or biopsy from the edge of an active ulcer. Unlike common STIs, a simple urine test is not sufficient to diagnose granuloma inguinale. UK patients are encouraged to be open with their doctors about their travel history, as this significantly aids in reaching an accurate diagnosis quickly.

The good news is that donovanosis is curable with a full course of antibiotics. According to standard UK clinical pathways, the first-line treatment is typically a long course of azithromycin, often taken once a week for several weeks or until the sores have completely healed. Alternative antibiotics, such as doxycycline, erythromycin, or ciprofloxacin, may be prescribed depending on the patient's medical history and the severity of the infection.

Patients must complete the entire course of medication, even if the sores appear to be healing quickly. Stopping treatment early can lead to a relapse. Furthermore, the NHS recommends that all recent sexual partners be informed and screened, even if they do not currently have symptoms, to prevent reinfection and further spread.

If you notice any unusual lumps, bumps, or sores in your genital area, it is essential to seek medical advice promptly. You can speak to a GP online or book a consultation with a private online doctor service for a confidential assessment. An online doctor can discuss your symptoms, review your travel history, and provide guidance on the necessary diagnostic steps.

Choosing an online GP consultation offers a discreet way to manage your sexual health from the comfort of your home. If the doctor suspects an infection like donovanosis, they can provide the necessary referral to a specialist clinic or, in confirmed cases, facilitate the prescription of appropriate antibiotic treatment. Early intervention is key to avoiding the long-term complications associated with chronic genital ulcer disease.

With appropriate antibiotic therapy, the prognosis for granuloma inguinale is excellent. Most ulcers heal within a few weeks of starting treatment. However, because the infection is chronic, patients are usually advised to attend follow-up appointments to ensure the bacteria has been fully eradicated.

To prevent donovanosis and other STIs, the use of barrier methods such as condoms is highly effective. If you are travelling to regions where the infection is more common, remaining vigilant about sexual health and ensuring you have access to reputable healthcare services if symptoms arise is vital. Regular STI screenings are a cornerstone of maintaining sexual well-being for anyone who is sexually active with new or multiple partners.