By Rachel Pannett
Washington - Some doctors in Britain are worried about an apparent rise in the number of cases of donovanosis, a sexually transmitted infection described as "flesh-eating" because of the damaging nature of its genital ulcers and sores.
Donovanosis infections are rare in developed countries. It is mostly found in tropical areas, including Papua New Guinea, parts of Central America, southern Africa and southern India. British government figures indicate it is nowhere near as prevalent as more common STIs such as chlamydia and gonorrhoea.
But that hasn't stopped alarm on social media after local media outlets quoted a London doctor saying the infection "is becoming more common on these shores."
A TikTok video in which another British physician listed its gory symptoms and described it as "terrifying" garnered more than 1.5 million views in about 24 hours.
Q: What is donovanosis?
A: Donovanosis is caused by the bacterium Klebsiella granulomatis. The condition does not actually eat the skin, but it has been dubbed "flesh-eating" because of what the Centers for Disease Control and Prevention describes as "beefy red" ulcers that damage the tissue of a person's genitals. If left untreated, it can spread to other parts of the body.
The disease is most commonly spread through vaginal or anal sex.
Q: What are the symptoms of donovanosis?
A: The initial symptoms are relatively painless, as the lesions form slowly on the genitals and perineum. But if untreated, it becomes a "debilitating and stigmatizing" condition that can cause "serious tissue damage" in the genital area and beyond, according to John Kaldor, a professor at the Kirby Institute at Australia's University of New South Wales, which researches infectious diseases.
Frank Bowden, a doctor who helped eliminate an outbreak in Aboriginal communities in northern Australia, said people would disappear into the bush, rather than seek out treatment, with disastrous results.
"I'm an infectious-diseases physician, and I'd never seen anything like it in my life. Untreated it's terrible," said the retired Australian National University medical professor.
Q: Is there a cure for donovanosis?
A: Antibiotic treatments are available, including azithromycin, doxycycline, erythromycin and trimethoprim-sulfamethoxazole. But the CDC says that patients and their physicians should watch out for potential relapse six to 18 months after completing treatment. Infections that cause ulcers around the genitals also increase the likelihood of HIV transmission, public health officials say.
Unlike gonorrhoea or syphilis, which can be asymptomatic, people with donovanosis almost always have detectable symptoms. "Western-educated people don't like things on their genitalia, so they seek treatment," Bowden said.
Q: Should people in Britain worry about donovanosis?
A: No, based on current numbers. Between 2016 to 2020, there were between 18 and 30 cases detected in England each year, according to Public Health England. Eighteen infections were logged in 2020, down from 30 in 2019, as widespread social distancing curbed its spread, along with those of other STIs.
"With totals in high teens and 20s over the past few years, I don't think we can say that it is clearly increasing, as there will inevitably be some random fluctuations," said the Kirby Institute's Kaldor.
But he says more research is needed to find out who is affected. For instance, if there is widespread transmission occurring in a particular part of the country, or a particular community, it might be classified as a localized outbreak.
Q: Who is most at risk of getting donovanosis?
A: Most people who are infected are between the age of 20 and 40, according to the US National Library of Medicine, and the condition is more common in men than women. In the United States, the small number of cases each year typically occur in people who have travelled to or are from places where the disease is common.
The best way to prevent the STI is through condom use.