Granuloma inguinale (GI) is a chronic genital granulomatous ulcerative disease caused by the gram-negative bacillus Klebsiella granulomatis, an intracellular gram-negative bacterium.

GI is thought to be sexually transmitted, with low infectivity.

The disease occurs rarely in the United States, although it is endemic in some tropical and developing areas, including India; Papua, New Guinea; the Caribbean; central Australia; and southern Africa.

No FDA-cleared molecular tests for the detection of K. granulomatis DNA exist, but such an assay might be useful when undertaken by laboratories that have conducted a CLIA verification study.

The initial lesion is a nonspecific papule or a nodule that ulcerates.

GI appears in the genital, pubic, perineal, groin, or perianal areas.

The ulcer is painless, slowly progressive, and has an undermined border.

The lesions are highly vascular (i.e., beefy red appearance) and bleed easily on contact.

There is no regional lymphadenopathy.

The presence of pain or adenitis suggests superinfection.

Subcutaneous granulomas (pseudoboboes) might also occur.

Extragenital lesions occur in 3% to 6% of cases can occur with extension of infection to the pelvis, or it can disseminate to intra-abdominal organs, bones, or the mouth.

The causative organism is difficult to culture.

Smears from the edge of the lesion may show characteristic Donovan bodies (organisms within macrophages).

The biopsy specimen should be taken from the edge of the lesion.