Skip to main content

Military Health System

Important Notice about Pharmacy Operations

Change Healthcare Cyberattack Impact on MHS Pharmacy Operations. Read the statement to learn more. 

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...

Report
Aug 1, 2023

MSMR Vol. 30 No. 8 - August 2023

.PDF | 1.02 MB

The August 2023 MSMR provides the most recent data from the active surveillance program for acute respiratory disease and Group A Beta-Hemolytic Streptococcus among U.S. Army basic trainees; then summarizes the case report of an extensively resistant E. coli in a returning traveler at Hawai'i's Tripler Army Medical Center; followed by a Surveillance ...

Article
Aug 1, 2023

Active Surveillance for Acute Respiratory Disease Detected No Outbreaks at Four U.S. Army Basic Training Installations in 2022

This article presents the 2022 results of the active surveillance program for acute respiratory disease and Group A Beta-Hemolytic Streptococcus conducted by the Defense Centers for Public Health-Aberdeen at the four Army installations responsible for basic combat training or one-station unit training. This ARD surveillance program rapidly monitors, ...

Article
Aug 1, 2023

Case Report: Complicated Urinary Tract Infection Due to an Extensively Resistant Escherichia coli in a Returning Traveler

This article presents the medical case report of a 76-year-old man who returned to the U.S. following overseas travel and was admitted at Hawai'i's Tri­pler Army Medical Center with a complicated urinary tract infection due to an extensively resistant strain of E. coli.

Report
Jul 1, 2023

MSMR Vol. 30 No. 7 - July 2023

.PDF | 1.30 MB

This continuation of the June issue, which published the annual quantification of health care provided by the Military Health System, continues with the impacts of various illnesses and injuries in 2022 among deployed service members; medical evacuations out of theaters of military operation; health care provision to non-service member MHS ...

Article
Jul 1, 2023

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries Among Non-Service Member Beneficiaries of the Military Health System, 2022

This report represents an updated summary of care provided to non-service members in the MHS during calendar year 2022. MHS beneficiaries are diverse and heterogeneous, including active component service members, activated National Guard and Reserve service members, active component immediate family, retirees, and their family members, with differing ...

Article
Jul 1, 2023

Medical Evacuations out of U.S. Central and U.S. Africa Command Among Active and Reserve Components, U.S. Armed Forces, 2022

This report summarizes the nature, numbers, and trends of conditions for which military members were medically evacuated from the U.S. Central Command (CENTCOM) or Africa Central Command (AFRICOM) operations during 2022, with historical comparisons to the previous four years.

Article
Jul 1, 2023

Morbidity Burdens Attributable to Various Illnesses and Injuries Among Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2022

This annual estimate of illness- and injury-related morbidity and health care burdens on the U.S. Armed Forces and MHS updates previous analyses of these burden distributions among active and reserve component service members in deployed settings. This report focuses on the health encounters of service members during deployment to U.S. Central Command ...

Report
Jun 1, 2023

MSMR Vol. 30 No. 6 - June 2023

.PDF | 1.55 MB

This annual issue quantifies the impacts of various illnesses and injuries in 2022 among members of the active component of the U.S. Armed Forces as well as the U.S. Coast Guard; health care burden metrics include the total number of medical encounters, including hospitalizations and ambulatory services, as well as numbers and types of individuals ...

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