# Donovanosis

> Donovanosis for NEET-PG Dermatology: Klebsiella granulomatis, Donovan bodies, the painless beefy red ulcer, pseudobubo and azithromycin therapy until healing.

- Canonical URL: https://prepelephant.com/topics/neet-pg/dermatology/donovanosis
- Exam / course: NEET-PG · Subject: Dermatology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: IADVL Textbook of Dermatology; NACO STI Treatment Guidelines
- How to cite: "Donovanosis", PrepElephant, https://prepelephant.com/topics/neet-pg/dermatology/donovanosis

## Direct answer

Donovanosis, also called granuloma inguinale, is a chronic, painless genital ulcerative infection caused by the gram-negative bacillus Klebsiella granulomatis. It produces a progressive, beefy red granulomatous ulcer that bleeds easily and spreads without true lymphadenopathy. The organism is identified by intracytoplasmic Donovan bodies in mononuclear cells, and treatment is azithromycin or doxycycline continued until the ulcer has completely healed.

## What you must remember

- **Causative organism:** Klebsiella granulomatis, formerly known as Calymmatobacterium granulomatis, a gram-negative bacillus that grows inside macrophages.
- **Donovan bodies:** intracytoplasmic encapsulated organisms in mononuclear cells, seen with Giemsa or Leishman stain in a smear from the ulcer edge, with a safety-pin appearance.
- **Clinical ulcer:** a painless, progressive, beefy red granulation tissue ulcer that bleeds readily on contact and has a rolled, clearly demarcated edge.
- **Pseudobubo:** the inguinal swelling is a granulomatous extension rather than a true lymph node bubo, so it is described as pseudobubo.
- **Drug of choice:** azithromycin 1 g orally once weekly, given for at least three weeks and continued until the lesions have completely healed.
- **Alternative regimen:** doxycycline 100 mg twice daily for at least three weeks, with ciprofloxacin and erythromycin as other options.
- **Geography:** the disease is historically endemic in parts of India and other tropical regions, is now uncommon, and is rare in most high-income settings.

## A stepwise approach to the painless genital ulcer

Donovanosis is easy to confuse with other genital ulcers, so the diagnosis rests on a sequence of clinical and laboratory checks. The steps below set out the examinable pathway.

1. **Recognise the painless ulcer:** a bleeding, beefy red, progressive lesion without tenderness points away from herpes and chancroid, which are painful.
2. **Take a tissue sample:** a scraping or biopsy from the ulcer edge is examined, because Donovan bodies on Giemsa or Leishman staining confirm the diagnosis.
3. **Exclude the differential:** syphilis, chancroid, lymphogranuloma venereum, tuberculosis and carcinoma are excluded with serology, culture and histology as indicated.
4. **Test for HIV:** every patient with donovanosis should be screened for HIV, because coinfection is common and affects healing.
5. **Treat until healing:** azithromycin weekly, or doxycycline twice daily, is continued for at least three weeks, and the course ends only when the ulcer is fully epithelialised.
6. **Follow up and trace partners:** the clinician checks healing at intervals and examines sexual contacts, because relapse follows an incomplete course.

## Where the exam plants its traps

Stems on donovanosis test the painless ulcer, the pseudobubo and the duration of therapy.

- **Trap:** diagnosing a painless ulcer with inguinal swelling as LGV and treating with doxycycline for 21 days — **Correct:** LGV has a true matted bubo and the groove sign, whereas donovanosis produces a pseudobubo without true lymphadenopathy.
- **Trap:** giving a single dose of azithromycin and calling the course complete — **Correct:** the regimen is weekly azithromycin for at least three weeks, until the ulcer has healed.
- **Trap:** expecting the bacterium on routine Gram stain as the key clue — **Correct:** Donovan bodies in mononuclear cells are the classic diagnostic feature on Giemsa-stained tissue.

## Frequently asked questions

### What are Donovan bodies in donovanosis?

Donovan bodies are intracytoplasmic, encapsulated Klebsiella granulomatis organisms seen inside mononuclear cells in tissue from the ulcer edge. They are visualised with Giemsa or Leishman stain and give a characteristic safety-pin appearance.

### Which inguinal swelling is seen in donovanosis?

Donovanosis produces a pseudobubo, which is granulomatous extension of the genital ulcer into the inguinal region rather than true lymph node enlargement. It is an important differential from the matted true bubo of lymphogranuloma venereum.

### How long must azithromycin be given for donovanosis?

Azithromycin 1 g orally once weekly is given for at least three weeks, and the course is continued until the ulcer has completely healed. Stopping earlier risks relapse, and the same principle of treating until healing applies to doxycycline.

### What is the characteristic appearance of a donovanosis ulcer?

A donovanosis ulcer is painless, progressive and beefy red, with a granular base that bleeds easily when touched. It is typically clearly demarcated, and its margin is rolled rather than undermined as in chancroid.