Donovanosis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]; Kiran Singh, M.D. [3]; Nate Michalak, B.A.

Overview

Donovanosis is commonly characterized as painless, progressive ulcerative lesions without regional lymphadenopathy. Patients in later stages may present with scarring, elephantiasis-like swelling of genitals or perianal area, or stenosis of the urethra, vagina, or anus. Typical lesion characteristics include: beefy red color, nontender, emitting rank odor, elevated above skin, smooth and rolled edge, serpiginous outline. Physical examination of lesions can classify donovanosis into ulcerogranulomatous, hypertrophic, necrotic, and sclerotic variants. Common locations in males include: coronal sulcus, subpreputial region, and anus. Common locations in females include: labia minora, cervix, and fourchette.

Physical Examination

In early stages donovanosis commonly presents as a nontender, progressive ulcerative lesions without regional lymphadenopathy.^[1]

90% of cases involve genital region
10% of cases involve inguinal region

Patients in late stages present with the following signs:^[2]

Scarring
Elephantiasis-like swelling
Stenosis of the urethra, vagina, or anus

Typical Lesion Characteristics

Beefy red color
Nontender
Emit rank odor
Elevated above skin
Smooth, rolled edge
Serpiginous outline^[3]

Four variants can be further classified according to their clinical presentation:^[1]

Type	Clinical Appearance
Ulcerogranulomatous	beefy red, non-tender, bleeds easily
Hypertrophic or Verrucous	irregular edge, dry
Necrotic	foul smelling, deep, tissue destruction
Sclerotic	dry, cicatricial, fibrous scar tissue

Common Locations in Males

Common Locations in Females

Extragenital Lesion Locations

Extragenital lesions occur in 6% of patients, typically in the following locations:^[3]

Gallery

Genital ulcer in a male patient with Donovanosis.Adapted from Dermatology Atlas.^[4]
Genital ulcer in a female patient with Donovanosis.Adapted from Dermatology Atlas.^[4]
Donovanosis. Adapted from Dermatology Atlas.^[4]
Granuloma inguinale, or Donovanosis, accompanied by perianal skin ulceration due to the bacterium, Klebsiella granulomatis. Adapted from Dermatology Atlas.^[4]
Donovanosis of penis. Adapted from Dermatology Atlas.^[4]
Donovanosis of penis. Adapted from Dermatology Atlas.^[4]
Preputial granulomatous lesion due to Donovanosis. Adapted from Dermatology Atlas.^[4]
Bilaterally infected inguinal lymph nodes due to a Calymmatobacterium granulomatis bacteria. Adapted from Dermatology Atlas.^[4]
This patient presented with a case of systemically disseminated Donovanosis of the ankle due to C. granulomatis bacteria. From Public Health Image Library (PHIL). ^[5]
This male presented with a penile lesion that was found to be granuloma inguinale, also called “genital ulcerative disease”. From Public Health Image Library (PHIL). ^[5]
This male presented with a penile lesion of roughly 40 days duration that was determined to be granuloma inguinale. From Public Health Image Library (PHIL). ^[5]
This 19 year old woman presented with an perianal granuloma inguinale lesion of about 8 months duration. From Public Health Image Library (PHIL). ^[5]
This patient presented with an ulcerated glans penis due to Donovanosis, or granuloma inguinale. From Public Health Image Library (PHIL). ^[5]
This image depicts an intravaginal view revealing a cervical lesion, which had been diagnosed as a case of Donovanosis, also known as granuloma inguinale. From Public Health Image Library (PHIL). ^[5]
This image depicts the penis of a male with its foreskin retracted, revealing a suppurative lesion involving the glans and prepuce. From Public Health Image Library (PHIL). ^[5]
This image depicts the penis of a male patient who had presented with a lesion located on the lateral preputial skin just proximal to the corona of the glans. The lesion was characterized as a penile granulomata, due to a case of Donovanosis, or granuloma inguinale. From Public Health Image Library (PHIL). ^[5]
This patient showed manifestations of granuloma inguinale, also known as Donovanosis, involving swelling and subcutaneous granulomas of the inguinal lymph nodes, bilaterally. From Public Health Image Library (PHIL). ^[5]
This was a very large erosive cutaneous lesion in the perineal region of this patient, which had been diagnosed as Donovanosis, otherwise known as granuloma inguinale. From Public Health Image Library (PHIL). ^[5]