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Groin granuloma (donovanosis): causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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Granuloma inguinale is a rare disease in the United States caused by the intracellular Gram-negative bacterium Calymmatobacterium granulomatis. The disease is endemic in certain tropical and developing areas, including India, New Guinea, central Australia, and southern Africa. The clinical manifestations of the disease are painless, progressive ulcerative lesions without regional lymphadenopathy. The lesions are highly vascular (red beef appearance) and bleed easily on contact. The organism is not cultured on standard culture media, and diagnosis is based on the demonstration of Donovan bodies in tissue preparations or biopsy. Secondary bacterial infection or the presence of another STD may occur.
Treatment of granuloma inguinale (donovanosis)
Therapy stops the progressive destruction of tissue, although the process of granulation and re-epithelialization of ulcers often requires long-term treatment. Relapse may occur after 6-18 months, despite the effectiveness of initial therapy.
Recommended treatment regimens for granuloma inguinale (donovanosis)
Trimethoprim-sulfamethoxazole 2 tablets orally 2 times a day for at least 3 weeks,
Or Doxycycline 100 mg orally 2 times a day for at least 3 weeks
Treatment should be continued until the lesions are completely healed.
Alternative schemes
Ciprofloxacin 750 mg orally 2 times daily for at least 3 weeks
Or Erythromycin 500 mg orally 4 times a day for at least 3 weeks
With any of the above regimens, the addition of an aminoglycoside (gentamicin 1 mg/kg IV every 8 hours) is recommended if there is no improvement within the first few days.
Follow-up observation
Patients should be kept under clinical observation until signs and symptoms of the disease resolve.
Management of sexual partners
Persons who have had sexual contact with patients with granuloma inguinale should be examined and treated if (a) they had sexual contact within 60 days before the onset of symptoms in the patients, or (b) they have symptoms or signs of the disease.
Special Notes
Pregnancy
Pregnancy is a relative contraindication to the use of sulfonamides. Pregnant and lactating women should be treated with erythromycin. Parenteral administration of aminoglycosides (eg, gentamicin) is recommended.
HIV infection
Individuals with HIV infection and granuloma inguinale should be treated according to the treatment regimens described. A parenteral aminoglycoside such as gentamicin should be added.
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