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Granuloma inguinale

By: RSC Editorial Team

June 5, 2022

Granuloma Inguinale: What You Should Know About This Rare STD

Most people are familiar with common sexually transmitted diseases, such as chlamydia, gonorrhea, HIV, and herpes. However, what you may not know is that there are also hundreds of rarer STDs that, if left untreated, can have devastating consequences for your health. 

Knowing about diseases such as granuloma inguinale, also known as donovanosis, can help you seek treatment sooner and prevent its spread to your sexual partners.

The Cause of Granuloma Inguinale (aka Donovanosis)

Granuloma inguinale, aka donovanosis, is the result of a Klebsiella granulomatis infection. The bacteria penetrate and eat the cell but grow relatively slowly, meaning that disease progression can take up to 12 weeks to reach its peak. 

Donovanosis is a sexually transmitted infection contractable through anal or vaginal sex with an infected partner. We know of some instances of patients developing oral lesions, but these are usually secondary symptoms, with the primary lesions growing on the genitals. Due to its rarity, most same-day STD testing kits do not test for this disease.

Symptoms of Granuloma Inguinale

Granuloma inguinale symptoms generally start as mild, but if left untreated, the disease can wreak havoc on your genital area. The infection can result in extensive blood and mucous leakage from open sores and potentially fatal secondary infections by other pathogens.

Stage One

The first stage of granuloma inguinale or donovanosis starts with a small pimple or lump in the genital region. The bump will spread and become pink or faintly red. The bumps eventually turn into raised red nodules that are painless but will bleed profusely if scratched or disrupted.

Stage Two

During the second stage, the bacteria continue eating away at the surrounding tissue and will start attacking the epidermis. This attack leads to shallow ulcers that spread from the initial area into the rest of the genital area, even extending into the thighs and lower abdomen. 

At this point, the ulcers develop a granular-looking halo of tissue while the inner part of the ulcer starts to weep or bleed frequently. This granulation tissue contains higher amounts of Donovan bodies, which are granular cellular components that form as a response to the infection.

Stage Three

The final stage is a deepening of the lesions and formation of scar tissue. In extreme examples, the disease can eat away enough flesh to cause severe injuries in affected individuals.

Five Main Types of Donovanosis Ulcer

A donovanosis ulcer can present in several unique ways, affecting diagnostic and treatment considerations.

Ulcerogranulomatous or Ulcerovegetative

The most common clinical presentation of this genital ulcerative disease, ulcerogranulomatous granuloma inguinale, starts with a single lesion or multiple hard, small pimple-like lesions that turn into soft, painless ulcers. These ulcers bleed easily and eventually develop sharp margins with rolled borders and a red granular base. Left untreated, these ulcers will continue to grow. 


Hypertrophic ulcers are much bigger than a traditional donovanosis ulcer. These lesions look like walnuts and result from large masses growing into each other.

Necrotic Ulcers

In most cases, granuloma inguinale ulcers contain living tissue, so the ulcers bleed heavily when injured. In some situations, the tissue in the ulcers starts to die, resulting in secondary infections and deep, foul-smelling ulcers.

Fibrous Ulcers

Fibrous ulcers contain large amounts of scar tissue and tend to develop during the later stages of the disease.

Nodular Type

Nodular donovanosis presents as a mixture of small, firm lesions (papules) and larger nodules that are soft, red, and contain small amounts of granulation tissue.

Diagnosing Donovanosis (Granuloma Inguinale)

Unlike many common STDs, donovanosis doesn’t have a rapid STD test to make an accurate and fast diagnosis. Since the initial bumps are small and painless, most people wait until the second or third stage before contacting their healthcare professional. 

Since Klebsiella granulomatis is difficult to grow in the lab, doctors rely on microscopy to make a diagnosis. In most cases, the presence of Donovan bodies in the granular tissue is enough to confirm the diagnosis.

Flesh-Eating STD Treatment Options and Prevention

The most common treatment for granuloma inguinale is a course of antibiotics for a minimum of three weeks, or until the lesions heal. Individuals should not participate in sexual activity during their treatment, and most doctors also recommend follow-up testing to confirm a complete recovery before starting sexual intercourse (Learn whether giving someone an STD is illegal). 

Like almost all other STDs, safe-sex practices can reduce the chance of catching donovanosis. Thankfully, most cases of granuloma inguinale occur in tropical areas, such as South East Asia, India, and South America, with only rare cases reported in the United States. 

However, while your risk of catching this flesh-eating STD may be low, your risk of catching more common STDs is significantly higher, and it’s vital to take the necessary precautions.

Test Regularly to Catch STDs Early

While you won’t detect donovanosis with Rapid Testing’s 10-panel STD test, these tests are still incredibly valuable in discovering the presence of more common STDs. If you engage in unprotected sex or have multiple sexual partners, order an STD test or visit your local testing center to keep you and your partner healthy and safe. Call us at Rapid STD Testing at (866) 872-1888 if you have any questions.


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By: RSC Editorial Team
June 5, 2022

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