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Doctors worried about rare STI

Gudrun Heise
October 29, 2021

A rare sexually transmitted infection called donovanosis, which causes ulcers and damaging scarring of the genitals, is getting attention after doctors say cases are rising in the United Kingdom.

 Klebsiella bacteria
Donovanosis is caused by the bacterium klebsiella granulomatisImage: Alissa Eckert/Science Photo Library/imago images

Donovanosis causes thick ulcers on the genitals. Both men and women can contract it, but men are twice as likely to be affected. It is generally transmitted through unprotected sex.

Also called granuloma inguinale, donovanosis is a bacterial infection that has been dubbed "flesh-eating" because it causes extensive inflammation of the genitals. It does not actually eat the flesh.

Typical initial symptoms are itchy sores or raised lumps in the genital and anal areas that increase in size and have a "beefy red” appearance. These can develop into ulcers that can become infected. If left untreated, donovanosis attacks and gradually destroys the genital tissue, causing scarring.

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An infection from the tropics

Donovanosis is found mainly in tropical areas, in countries such as India, Papua New Guinea, and central and northern Australia. Cases have also been reported in Vietnam and some African countries.

It belongs to the category of STIs or sexually transmitted infections. In Europe, it remains rather rare, with chlamydia, syphilis or even gonorrhea still topping the list of the most common STIs.

Now, however, some doctors in the UK are warning that donovanosis is spreading in the country, with cases ticking up.

This is how donovanosis progresses

Since donovanosis does not cause pain, it is often not recognized directly. Reddish nodules form at the site where the bacteria enter the body. But they disappear relatively quickly. Ulcers then develop near the affected area. They bleed when touched. They can appear on different parts of the body, but they usually affect the genitals.

In men, the penis is affected, and in women, the labia. If the infection is not treated early, it leads to pus-filled inflammation that eventually damages the genital tissue. The incubation period is nonspecific, with anywhere between one and 16 weeks between the actual infection and the outbreak of donovanosis.

Diagnosis via a smear test or biopsy

Most people who contract donovanosis are between 30 and 40 years old. To diagnose the infection, the doctor takes a smear from the affected part of the body or a tissue sample. If that does not bring a clear result, a cell culture of the ulcer can be done.

That can also help the doctor determine whether it is actually donovanosis or another STI with similar symptoms. That includes syphilis, for example.

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Early treatment is important

Once donovanosis is confirmed, the doctor usually treats the patient with antibiotics. If that happens relatively quickly, the infection can clear up completely.

If it is already at an advanced stage, the infection could, however, lead to edema or swelling, the urethra, vagina or anal canal can narrow and there can be permanent scarring.

In such cases, surgery is the only solution. The body does not build up immunity against a new infection. That means even after having donovanosis, the patient is not protected.

Condoms provide protection against transmission

As with almost all sexually transmitted infections, condoms offer the best protection. Using them is particularly recommended when traveling to tropical and subtropical countries where the bacterial infection is often endemic.

Colorful condoms
Experts say condoms provide good protection against sexually transmitted infections and diseasesImage: Fotolia/Sergejs Rahunoks

In Germany, public health agency Robert Koch Institute, among others, provides information about donovanosis and other STIs that can become an unwanted souvenir when traveling abroad.

This article has been translated from German.