Skip main navigation

Military Health System

Clear Your Cache

Health.mil has undergone a recent update. For the best user experience we recommend clearing your browser cache.

Surveillance Snapshot: Donovanosis Among Active Component Service Members, U.S. Armed Forces, 2011–2020

Image of 3_Surveillance snapshot_Donovanosis. This photomicrograph of a tissue sample extracted from a lesion in the inguinal region of the female granuloma inguinale, or Donovanosis patient, depicted in PHIL 6431, revealed a white blood cell (WBC) that contained the pathognomonic finding of Donovan bodies, which were encapsulated, Gram-negative rods, representing the responsible bacterium Klebsiella granulomatis, formerly known as Calymmatobacterium granulomatis. Photo credit: CDC/ Susan Lindsley

Donovanosis, or granuloma inguinale, is an uncommon sexually transmitted infection (STI) that is much rarer than chlamydia, gonorrhea, and syphilis. Donovanosis is found mainly in tropical regions, and is highly correlated with populations affected by poverty and lack of access to hygiene and public health infrastructure. However, recent news reports have described donovanosis as a "flesh-eating" STI that may be increasing in incidence in developed countries.1–3

Donovanosis is a bacterial infection of the skin and mucous membranes in the genital region.4–5 Early lesions are small, painless nodules that grow into characteristic "beefy red" highly vascular ulcers and progressively expand. Untreated cases can result in tissue destruction and scarring. Although clinical diagnosis is possible, ulcers may be hard to differentiate from those associated with syphilis, chancroid, HIV-associated herpes, amoebiasis, and carcinoma. For this reason, confirmation via staining of tissue or biopsies is recommended. The causative agent is Klebsiella granulomatis, a gram-negative intracellular bacillus, which produces characteristic Donovan bodies within mononuclear cells upon staining. Antibiotics such as azithromycin, doxycycline, erythromycin, ciprofloxacin, and trimethoprim-sulfamethoxazole are curative over a 3-week course or until sores have healed.

For this analysis, the Defense Medical Surveillance System was searched for records of inpatient and outpatient care for diagnoses of donovanosis. A case was defined by the recording of 1 inpatient or outpatient diagnosis of donovanosis (International Classification of Diseases, 9th Revision Clinical Modification [ICD-9-CM]: 099.2; ICD-10-CM: A58) in the primary diagnostic position. An individual could be counted as an incident case only once during the surveillance period (2011–2020). The surveillance population included all individuals who served in the active component of the Army, Navy, Air Force, or Marine Corps at any time during this period. During the 10-year period, there were 50 incident cases of donovanosis. Cases were split relatively evenly by sex (female service members: 54%; male service members: 46%) and most cases occurred in those aged 20–29 (56%) (data not shown). The annual numbers of cases ranged from 3 to 10 with no discernable trend over time (Figure).

Although the incidence of donovanosis has been very low among service members, it is important for health care providers to be aware of trends of emerging STIs particularly among young, sexually active individuals who may travel to endemic areas. As with other STIs, the best prevention of donovanosis is protected sex.

Author Affiliations: Defense Health Agency, Armed Force Health Surveillance Division (Ms. Daniele and Mr. Wilkerson).

References

  1. Purves R. Doctors warning as 'flesh-eating' STI hits UK. Birmingham Live. 21 Oct. 2021. Accessed 22 Nov. 2021. https://www.birminghammail.co.uk/news/health/what-donovanosis-flesh-eating-sti-21924441
  2. Lee B. Donovanosis: Why this is called a 'flesh eating' sexually transmitted infection. Forbes. 24 Oct. 2021. Accessed 22 No. 2021. https://www.forbes.com/sites/brucelee/2021/10/24/donovanosis-why-this-is-called-a-flesh-eating-sexually-transmitted-infection/?sh=423fc60112b4
  3. Gardiner, Alistair. Should doctors be concerned over this 'flesh-eating' STD? MDLinx. 4 Nov. 2021. Accessed 22 Nov,r 2021. https://www.mdlinx.com/article/should-doctors-be-concerned-over-this-flesh-eating-std/yKQ59ow980YmcCNPqVxiR
  4. Satter EK. Granuloma inguinale (donovanosis). Mescape. Updated 25 Oct. 2021. Accessed 22 Nov. 2021. https://emedicine.medscape.com/article/1052617
  5. O'Farrell N. Donovanosis. Sex Transm Infect. 2002;78(6):452–457.

FIGURE. Cases of donovanosis among active component service members, U.S. Armed Forces, 2011–2020

You also may be interested in...

Topic
Mar 28, 2025

Medical Surveillance Monthly Report

The Medical Surveillance Monthly Report, a peer-reviewed journal launched in 1995, is the Armed Forces Health Surveillance Division's flagship publication. The MSMR provides monthly evidence-based estimates of the incidence, distribution, impact, and trends of health-related conditions among service members.

Article
Mar 1, 2025

Correlation Between Mean Temperature and Incidence of Tick-borne Diseases Among Active Duty Service Members in the Contiguous U.S., 2000–2023

This study identifies the incidence of the two tick-borne diseases, Lyme disease and Rocky Mountain spotted fever, that are most frequently diagnosed within the Military Health System among active component U.S. service members and evaluates the correlation between temperature and incidence of each tick-borne disease.

Article
Mar 1, 2025

Non-Medical Risk Factors Influencing Health and Association with Suicidal Ideation or Attempt, U.S. Active Component, 2018–2022

This study reports the prevalence of non-medical risk factors, also known as social determinants of health, among active component U.S. service members and assesses the relationship between these factors and suicide ideation or attempts between 2018 and 2022. This study documents, for the first time, the frequency of diagnosis for non-medical risk ...

Article
Feb 1, 2025

Development of a New Fleet Disease and Injury Surveillance Capability Using ESSENCE

This report details the steps taken to develop a timely, accurate, and comprehensive Navy fleet disease and injury surveillance capability, utilizing ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics), including the successes and challenges that will guide further refinement and expansion of this tool.

Article
Feb 1, 2025

Surveillance Snapshot: Non-Hodgkin Lymphoma Incidence in Active Component U.S. Service Members, 2017–2023

This analysis utilizes an updated case definition for non-Hodgkin lymphoma developed by the Armed Forces Health Surveillance Division, based on consultation with subject matter experts and previous literature, to establish non-Hodgkin lymphoma incidence within the U.S. Armed Forces active component, from 2017 through 2023.

Article
Feb 1, 2025

External Cause Coding of Injury Encounters in the Military Health System Among Active Component U.S. Service Members, 2016–2019

Knowledge of injury causes is essential for prevention. This article describes causes of injury for all U.S. service members, from 2016 through 2019, and identifies variations in injury cause coding over time, and by branch of military service, type of health care visit and facility, and diagnosis category.

Article
Jan 1, 2025

Use of Positive Predictive Value to Evaluate the Armed Forces Health Surveillance Division Brain Cancer Incidence Rules, Active Component Department of the Air Force Pediatric Dependent Population, January 1, 2010–December 31, 2020

This study applied the Armed Forces Health Surveillance Division (AFHSD) case definition for the identification of malignant brain tumors among U.S. active service members to the dependent pediatric population of the active component of the U.S. Air Force, to determine the positive predictive value of this case definition for a pediatric population.

Skip subpage navigation
Refine your search
Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery