Epidemiology of Granuloma Inguinale (Donovanosis)

Granuloma inguinale (donovanosis) represents a genital ulcerative disease of the skin and mucosa that is caused by the Gram-negative, intracellular bacterial pathogen Klebsiella granulomatis comb. nov. (also known as Calymmatobacterium granulomatis). In contrast to lymphogranuloma venereum and chancroid, this disease does not involve lymph nodes.

Knowing and understanding the epidemiology of the disease is important for undertaking prevention efforts; however, the causative microorganism is difficult to culture, thus the diagnosis often necessitates the visualization of dark-staining Donovan bodies (although molecular techniques have been becoming more pervasive in recent years).

Geographical Distribution

The disease is quite rare in the United States (US) and Europe, and is mostly seen in immigrants and returning travelers. On the other hand, granuloma inguinale is endemic in tropical and subtropical regions of the world, such as South Africa (especially in the provinces of East Transvaal and KwaZulu-Natal), Papua New Guinea, certain regions of India and Indonesia, but also among the Australian aborigines.

Furthermore, established donovanosis has been reported in Peru, Argentina, Brazil, Central America and the Caribbean, as well as French Guiana. It must be noted that during the last two decades the overall prevalence of this condition has decreased substantially, thus only sporadic cases are often seen – even in countries with high prevalence and disease endemicity.

Disease Incidence

Granuloma inguinale is usually considered as one of the minor sexually-transmitted diseases, as the prevalence is really low in Western Europe and the US. However, in India it accounts for up to 6.3% of all venereal diseases among the hospital population, and that number tends to be even higher in aforementioned countries.

The incidence of infection is greatest between 20 and 40 years of age, which is a period of sexual maturity. However, certain researchers have found a large number of cases in the age group between 11 and 30 years. Cases seen in children are usually a result of contact with adults that are infected, but not necessarily due to sexual abuse.

Even though earlier reports have shown a higher incidence of the disease in women, it seems men are more frequently affected nowadays. This condition has racial predilection for Afro-Americans, and is more common in those with deficient hygiene, as well as in people from a lower socio-economic status.

Epidemiological Characteristics

The main transmission pathway of donovanosis is a sexual intercourse, albeit direct contact and indirect contamination of genital region by fecal microbial flora are also considered as potential routes of infection (especially in children). Congenital infections (as a result of fetal infection) have not been reported in the medical literature.

Granuloma inguinale also has a highly variable incubation period, with an average of 17 days. Experimental production of full-blown lesions typical for this condition was successfully induced in volunteers 50 days after the inoculating the causative agent. The duration of disease may vary from six days to six years (the average being 152 days).

Moreover, granuloma inguinale increases the risk of acquiring human immunodeficiency virus (HIV) infection. For example, in Durban (a large city located on the east coast of South Africa) where HIV infection had been introduced quite recently, there was a surge in the proportion of men with concomitant donovanosis and HIV infection.


  1. http://www.antimicrobe.org/b108.asp
  2. https://www.ncbi.nlm.nih.gov/pubmed/26882914
  3. https://www.ncbi.nlm.nih.gov/pubmed/11394976
  4. https://medlineplus.gov/ency/article/000636.htm
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758360/
  6. www.scielo.br/scielo.php
  7. Lupi O, Chicralla P, Martins CJ. Donovanosis. In: Gross G, Tyring SK, editors. Sexually Transmitted Infections and Sexually Transmitted Diseases. Springer Science & Business Media, 2011; pp. 191-196.
  8. O’Farrell N. Donovanosis. In: Kumar B, Gupta S, editors. Sexually Transmitted Infections, Second Edition. Elsevier Health Sciences, 2014; pp. 533-541.

Further Reading

Last Updated: Feb 26, 2019

Dr. Tomislav Meštrović

Written by

Dr. Tomislav Meštrović

Dr. Tomislav Meštrović is a medical doctor (MD) with a Ph.D. in biomedical and health sciences, specialist in the field of clinical microbiology, and an Assistant Professor at Croatia's youngest university - University North. In addition to his interest in clinical, research and lecturing activities, his immense passion for medical writing and scientific communication goes back to his student days. He enjoys contributing back to the community. In his spare time, Tomislav is a movie buff and an avid traveler.


Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Meštrović, Tomislav. (2019, February 26). Epidemiology of Granuloma Inguinale (Donovanosis). News-Medical. Retrieved on June 22, 2024 from https://www.news-medical.net/health/Epidemiology-of-Granuloma-Inguinale-(Donovanosis).aspx.

  • MLA

    Meštrović, Tomislav. "Epidemiology of Granuloma Inguinale (Donovanosis)". News-Medical. 22 June 2024. <https://www.news-medical.net/health/Epidemiology-of-Granuloma-Inguinale-(Donovanosis).aspx>.

  • Chicago

    Meštrović, Tomislav. "Epidemiology of Granuloma Inguinale (Donovanosis)". News-Medical. https://www.news-medical.net/health/Epidemiology-of-Granuloma-Inguinale-(Donovanosis).aspx. (accessed June 22, 2024).

  • Harvard

    Meštrović, Tomislav. 2019. Epidemiology of Granuloma Inguinale (Donovanosis). News-Medical, viewed 22 June 2024, https://www.news-medical.net/health/Epidemiology-of-Granuloma-Inguinale-(Donovanosis).aspx.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
Post a new comment

While we only use edited and approved content for Azthena answers, it may on occasions provide incorrect responses. Please confirm any data provided with the related suppliers or authors. We do not provide medical advice, if you search for medical information you must always consult a medical professional before acting on any information provided.

Your questions, but not your email details will be shared with OpenAI and retained for 30 days in accordance with their privacy principles.

Please do not ask questions that use sensitive or confidential information.

Read the full Terms & Conditions.