What is Granuloma Inguinale?

Medically Reviewed By Elizabeth Thottacherry, MD
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Granuloma inguinale is a bacterial infection of the genital area that spreads through sexual contact. It is rare in the United States. With granuloma inguinale, painless, slow-growing, large red ulcers form. These ulcers may bleed.  Various different antibiotics can treat it and, if treated promptly, the outcome is generally positive. However, there is a risk of future relapse. If left untreated the infection can cause serious damage.

Read on to learn about granuloma inguinale, what the symptoms and stages are, and what the treatment plan is. This article also covers how it spreads, who is at risk, and how you can prevent it.

What is granuloma inguinale?

couple cuddling
Marc Bordons/Stocksy United

Granuloma inguinale, also called donovanosis, is an infection of the genitals most commonly found in individuals with insufficient hygiene.

It typically exists in tropical and subtropical areas like India, New Guinea, South Africa, Australia, Indonesia, the Caribbean, and Guyana.

There are only about 100 reported cases in the U.S. per year. Usually, those cases are people who have recently traveled from the areas where this condition is more common.

What are the symptoms of granuloma inguinale?

Symptoms generally occur between 1–12 weeks after coming in contact with the bacteria. However, researchers do not know the true incubation period for this infection.

At first, you may notice small red bumps or lesions on your genital area that do not hurt. Mouth or anal sores will only happen if sexual contact occurs with these areas. Rarely, these bumps can also occur outside the genital area when the bacteria extends through the pelvis, involving organs like the uterus. It can also spread to noncontiguous organs like bone or liver.

The bumps then progress through 3 stages:

Stage 1

In the first stage, the small red bumps or pimples will start to spread and grow bigger. Their coloring changes to pink or light red and they begin to turn into raised nodules that feel velvety. They still will not hurt but can bleed very easily.

Stage 2

In the second stage, the skin will start to erode from the bacteria. The nodules turn into shallow ulcers that spread to your groin area. The edges feel firm and are usually not very raised. The ulcers may start to smell foul in this stage and secondary bacterial infection can start to occur.

Stage 3

In the last stage, the tissue damage from the ulcers is deep and widespread, forming scar tissue.

Is granuloma inguinale curable?

You can cure granuloma inguinale by taking antibiotics. The earlier the treatment begins, the better the outcome and the less scarring there should be.

Treatment options

Treatment consists of antibiotics, usually taken for 3 weeks. Recommended antibiotics include

azithromycin, doxycycline, erythromycin, and azithromycin.

You should start seeing your body respond to the antibiotics after about 7 days.

Continue your follow-up appointments with your doctor for about 6 months after the sores get better. There is a possibility of reoccurrence even after treatment.

Talk with your current sex partners, as they may require treatment as well.  

What causes granuloma inguinale?

Granuloma inguinale is a sexually transmitted infection (STI) caused by the bacterium Klebsiella granulomatis, previously named Calymmatobacterium granulomatis.

Read more about sexually transmitted infections here.

How does granuloma inguinale spread?

You can get this STI by having vaginal or anal sex with a partner who has the infection. In rare cases, you can get it through oral sex.

If you have had sexual contact with a person who possibly has granuloma inguinale, seek advice from your doctor immediately.

Who is at risk?

You are at risk of getting granuloma inguinale if you have sexual contact with someone who lives or has been traveling in the tropics and subtropical regions. The infection is usually more prevalent in these areas:

  • India
  • New Guinea
  • South Africa
  • Australia
  • Indonesia
  • The Caribbean
  • Guyana

People who get granuloma inguinale are typically aged 20–40 years.  

Research suggests that people who do not maintain adequate personal hygiene tend to get it more often than those who do.

How is granuloma inguinale diagnosed?

To determine if you have granuloma inguinale, your doctor will send a culture or scraping of the ulcers for lab testing. A professional will observe the culture under a microscope for signs of the infection.

Complications of untreated granuloma inguinale

Untreated, granuloma inguinale can cause scarring, swelling, and loss of skin color in the genitals. This damage can be permanent.

If you suspect you may have it, seek treatment as soon as possible to prevent it from spreading and scarring.

There is also the potential for relapse after it seems the infection has been cured.

If the infection does not seem to be improving, further testing should be done to make sure there is no other underlying problem going on as well.

How can you prevent granuloma inguinale?

The only way to prevent granuloma inguinale completely is to avoid all sexual activity. However, following safer sex behaviors may help to decrease your risk.

Using condoms for the duration of each sexual activity greatly decreases your risk of getting an STI.

Outlook

Early treatment with antibiotics can help the ulcers start to heal and may prevent the spread of the ulcers. It will also decrease the amount of scarring and changes in skin color.

Summary

Granuloma inguinale is a bacterial infection of the genitals that spreads through sexual contact. It is more prevalent in the tropical and subtropical areas of the world. The U.S. only sees about 100 cases per year, typically occurring in people who have recently traveled to those areas.

The infection starts as red, painless bumps in the genital or anal area. The bumps then grow and eat away at the surrounding skin, causing an open ulcer to form. Untreated ulcers may cause permanent scar tissue and loss of pigmentation in the skin.

Treatment consists of at least 3 weeks of antibiotics and multiple follow-up visits to make sure you are healing. The condition can reoccur even after sores disappear.

The prognosis is good if treated early on. To avoid getting granuloma inguinale, avoid sexual contact with someone who has recently traveled to the tropics. Practice safe sex behaviors to decrease your risk of STIs.

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Medical Reviewer: Elizabeth Thottacherry, MD
Last Review Date: 2022 Apr 20
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