Granuloma Inguinale (Donovanosis): Symptoms & Signs

Granuloma inguinale (donovanosis) is a rare bacterial STI caused by Klebsiella granulomatis that produces painless, slowly enlarging, beefy-red genital ulcers that bleed easily on contact. It's very uncommon in the United States and seen mostly in a few tropical and subtropical regions. It spreads through sexual contact and is curable with a long antibiotic course CDC STI Guidelines.

What is granuloma inguinale (donovanosis)?

Granuloma inguinale is a chronic, progressive bacterial infection of the genital skin and underlying tissue. The bacterium responsible, Klebsiella granulomatis, invades the cells of the skin and multiplies, breaking down tissue over weeks. You get an open sore that grows steadily rather than appearing all at once.

For most US readers it comes down to rarity. Donovanosis is almost never seen domestically and clusters in parts of the world with endemic transmission. If you've never traveled to one of those regions and had a new partner there, the odds you have this particular infection are low. Far more common ulcer-causing STIs like herpes and syphilis explain most genital sores here. Still, recognizing its look matters, because the treatment is specific and the sore behaves differently from the others.

Symptoms and the silent reality

The classic lesion is unmistakable once you know it: a painless, beefy-red ulcer that bleeds readily when touched, usually on the genitals or perineum (the area between the genitals and anus). It starts small and enlarges slowly over time. The redness comes from the lesion's rich, granulating tissue base, which is also why even minor contact makes it bleed.

One of the most useful distinguishing features is what's missing. Donovanosis typically does not cause the swollen, tender groin lymph nodes that some other ulcer-causing STIs produce, so there's no painful "bubo" the way you'd see with chancroid or lymphogranuloma venereum. A painless sore that bleeds easily but isn't accompanied by sore swollen glands is a meaningful clue for a clinician.

Because the ulcer doesn't hurt, people often delay getting it looked at, assuming a painless sore can't be serious. That delay lets the lesion keep enlarging and lets damage accumulate. A painless genital ulcer is a reason to be seen now.

How granuloma inguinale spreads

Donovanosis spreads through sexual contact. Transmission involves direct contact with the lesions or infected tissue during sex, which is why the sores appear on the genitals and perineum where contact happens. Because the disease is so geographically concentrated, the realistic risk for most Americans relates to sexual contact in or with partners from endemic regions.

If you're not sure when an exposure happened or whether enough time has passed for a useful evaluation, read up on the timing at our guide to when to test after exposure so a visit isn't wasted.

How it's tested and diagnosed

Diagnosis starts with the look of the ulcer. A clinician who sees a painless, beefy-red, easily-bleeding sore without swollen nodes will already be thinking about donovanosis. The diagnosis is confirmed by examining a sample of the lesion tissue under the microscope, looking for the bacteria inside cells. Unlike most common STIs, there's no quick urine test for this one; the lesion sample confirms it.

In practice, getting evaluated for genital sores is straightforward. Most STI workups use a simple sample — a urine cup, a self-collected swab, or a quick exam — with results usually back in a few days, and they're free or low-cost at health departments, Planned Parenthood, and Title X clinics. For donovanosis specifically, expect the clinician to take a sample directly from the sore. If you have any genital ulcer, get tested for the more common ulcer causes at the same time, since herpes and syphilis are far likelier here and need their own treatment.

If you're weighing where to go, you can compare testing providers on cost, turnaround, and whether they handle in-person exams versus mail-in kits. Sores need an actual exam, so a clinic visit beats a home kit for this one.

Treatment: what to expect

Donovanosis is curable but demands patience. It needs a long antibiotic course: azithromycin (1 g once weekly or 500 mg daily) for at least 3 weeks and until all the lesions have fully healed. You keep treating until the sores are gone, which can run longer than the 3-week minimum.

Two things trip people up. Relapse can occur 6 to 18 months later even after treatment that looked successful, so follow-up matters and a recurrence isn't a sign you did something wrong. This is a defined course, so finish all of it even once you feel better and the sore is shrinking, because stopping early invites relapse. Ask your clinician whether your partner needs treating so you don't pass it back and forth.

Complications if it's left untreated

Because the lesion grows slowly and destroys tissue as it goes, untreated donovanosis causes progressive local damage. The longer it's left, the more skin and underlying tissue it consumes, and healing can leave scarring that distorts the genital area. An open, bleeding sore also makes the surrounding skin more vulnerable to other infections.

Like any genital ulcer, a donovanosis sore can ease the transmission of other STIs, including HIV, by giving them an entry point through broken skin. A painless sore deserves prompt attention rather than a wait-and-see approach.

How to lower your risk

Condoms used every time lower the risk of the sexually transmitted infections, donovanosis included, though a condom only protects the skin it covers, and lesions can sit outside that area. Routine testing catches infections that have no symptoms, and prompt evaluation of any new sore catches the rest. For a rare, region-specific infection like this, knowing a partner's travel and sexual history and being seen quickly if a painless ulcer appears are the most practical defenses.

When to see a clinician

See a clinician for any genital or perineal sore, especially a painless one that bleeds when touched or keeps slowly growing. Don't let the absence of pain reassure you. Be seen sooner if you've recently had sex in or with a partner from a region where donovanosis is endemic. A diagnosis here is treatable, and clinics handle genital sores daily.

• A painless genital sore that bleeds easily or won't heal.
• An ulcer that's slowly enlarging over days to weeks.
• Any new sore after sex in an endemic region.
• A partner diagnosed with donovanosis or any ulcer-causing STI.